| NPI | 1033154430 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JAYNE WALTER Credentialing 757-917-5356 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine |
| Additional Taxonomies | 207RG0300X Internal Medicine, Geriatric Medicine |
| 207RN0300X Internal Medicine, Nephrology | |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| 363L00000X Nurse Practitioner | |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2019-11-01 |