| Four Crowne Legacy Llc | |
|
6147 Jefferson Ave Ofc 2 Newport News VA 23605-1511 | |
| (757) 504-2191 | |
| Not Available |
| Full Name | Four Crowne Legacy Llc |
|---|---|
| Speciality | Nurse Practitioner - Psychiatric/mental Health |
| Location | 6147 Jefferson Ave Ofc 2, Newport News, Virginia |
| Authorized Official Name and Position | Ednora B Mason (BOARD MEMBER) |
| Authorized Official Contact | 7573425461 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Four Crowne Legacy Llc 317 Peach Tree Cres Newport News VA 23602-7494 Ph: (757) 504-2191 | Four Crowne Legacy Llc 6147 Jefferson Ave Ofc 2 Newport News VA 23605-1511 Ph: (757) 504-2191 |
| NPI Number | 1033092903 |
|---|---|
| Provider Enumeration Date | 07/29/2025 |
| Last Update Date | 07/29/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033092903 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
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