| NPI | 1013091115 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HAZLE KONERDING President 804-282-0831 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: VA 0101026447) |
| Additional Taxonomies | 207N00000X Dermatology (Licence: VA 0101233942) |
| 207ND0101X Dermatology, MOHS-Micrographic Surgery (Licence: VA 0101238054) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: VA 0101053332) | |
| 207NP0225X Dermatology, Pediatric Dermatology (Licence: VA 0101044250) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0017138217) | |
| 363LA2100X Nurse Practitioner, Acute Care (Licence: VA 0017137835) | |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2014-09-03 |