Provider Demographics
NPI:1053187211
Name:CREASY, STARR ELIZABETH
Entity type:Individual
Prefix:
First Name:STARR
Middle Name:ELIZABETH
Last Name:CREASY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:GOODVIEW
Mailing Address - State:VA
Mailing Address - Zip Code:24095-2428
Mailing Address - Country:US
Mailing Address - Phone:540-875-9299
Mailing Address - Fax:
Practice Address - Street 1:111 WOODLAKE DR
Practice Address - Street 2:
Practice Address - City:GOODVIEW
Practice Address - State:VA
Practice Address - Zip Code:24095-2428
Practice Address - Country:US
Practice Address - Phone:540-875-9299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT63242676343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)