| NPI | 1053450296 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SUSAN JANET MOLE Practice Mgr Corp. Secretary 276-623-8105 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101051200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101225410) |
| 208000000X Pediatrics (Licence: VA 0101051074) | |
| 208000000X Pediatrics (Licence: VA 0101059370) | |
| 208000000X Pediatrics (Licence: VA 0101050628) | |
| 208000000X Pediatrics (Licence: VA 0101028204) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024059099) | |
| 363LF0000X Nurse Practitioner, Family (Licence: VA 0024166814) | |
| Enumeration Date | 2007-02-05 |
| Last Update Date | 2010-11-01 |