Individual
LUVENIA LEA BROADNAX EZELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
1126 BIG BETHEL RD, HAMPTON, VA 23666-1906
(757) 776-5843
Mailing address
1126 BIG BETHEL RD, HAMPTON, VA 23666-1906
(757) 776-5843
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002095818
VA
Other
Enumeration date
01/18/2022
Last updated
01/18/2022
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