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1306106190
ELIZABETH LEE CROCKETT
VIRGINIA BEACH, VA
NPI
1306106190
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363AM0700X Physician Assistant, Medical
(Licence: VA 0110003870)
Enumeration Date
2012-05-25
Last Update Date
2012-05-25
Business Address
-- ELIZABETH LEE CROCKETT PA
4092 FOXWOOD DR STE 101
VIRGINIA BEACH, VA 23462-5225
Phone number: 757-686-3508
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Mailing Address
-- ELIZABETH LEE CROCKETT PA
PO BOX 7549
PORTSMOUTH, VA 23707-0549
Phone number: 757-686-3508
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