Individual
MS. MARY ELIZABETH BACON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN BSN CCM
Contact information
Practice address
620 JOHN PAUL JONES CIR STE 275, PORTSMOUTH, VA 23708-2197
(757) 953-0612
Mailing address
126 CONWAY AVE, NORFOLK, VA 23505-4422
(757) 403-1679
Taxonomy
Speciality
Code
Description
License number
State
163WC0400X
Case Management Registered Nurse
Primary
0001078291
VA
Other
Enumeration date
11/12/2024
Last updated
11/12/2024
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