| NPI | 1225835408 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GINGER FODDRELL Owner 804-402-4002 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP2300X Nurse Practitioner, Primary Care |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 363A00000X Physician Assistant | |
| 363LF0000X Nurse Practitioner, Family | |
| Enumeration Date | 2025-02-26 |
| Last Update Date | 2025-06-30 |