Provider Demographics
NPI:1962796771
Name:BOND, ELIZABETH CATHERINE WILCK (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:CATHERINE WILCK
Last Name:BOND
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MISS
Other - First Name:ELIZABETH
Other - Middle Name:CATHERINE
Other - Last Name:WILCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL STREET
Practice Address - Street 2:RADIOLOGY
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-0470
Practice Address - Country:US
Practice Address - Phone:804-828-6831
Practice Address - Fax:804-827-0089
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024-168399363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner