Basic Information
Provider Information | |||||||||
NPI: | 1962796771 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BOND | ||||||||
FirstName: | ELIZABETH | ||||||||
MiddleName: | CATHERINE WILCK | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | FNP-BC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WILCK | ||||||||
OtherFirstName: | ELIZABETH | ||||||||
OtherMiddleName: | CATHERINE | ||||||||
OtherNamePrefix: | MISS | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 91734 | ||||||||
Address2: |   | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232911734 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8043586100 | ||||||||
FaxNumber: | 8043427619 | ||||||||
Practice Location | |||||||||
Address1: | 1250 E MARSHALL STREET | ||||||||
Address2: | RADIOLOGY | ||||||||
City: | RICHMOND | ||||||||
State: | VA | ||||||||
PostalCode: | 232980470 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8048286831 | ||||||||
FaxNumber: | 8048270089 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/09/2011 | ||||||||
LastUpdateDate: | 11/04/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 0024-168399 | VA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
No ID Information.