| NPI | 1265215859 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NATHAN VARBANOFF Owner 804-000-0000 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 207R00000X Internal Medicine |
| Enumeration Date | 2023-08-16 |
| Last Update Date | 2024-04-11 |