| NPI | 1275168247 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | COURTNEY TERRY ZYDRON President 757-719-1141 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2020-03-10 |