| NPI | 1124537360 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ALICIA NICOLE ROSE Manager 757-460-4655 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health (Licence: VA 0024175122) |
| Enumeration Date | 2017-09-20 |
| Last Update Date | 2017-09-20 |