Provider Demographics
NPI:1932794849
Name:FUQUA, ELIZABETH NOEL (LAC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:NOEL
Last Name:FUQUA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8342 GREENOCK DR
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3234
Mailing Address - Country:US
Mailing Address - Phone:410-459-1508
Mailing Address - Fax:
Practice Address - Street 1:202 S ROBINSON ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-5116
Practice Address - Country:US
Practice Address - Phone:804-678-9816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0121-000989171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist