| NPI | 1336525823 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LATARA C HARRIS Owner 757-613-4224 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024170040) |
| Enumeration Date | 2015-08-06 |
| Last Update Date | 2015-08-06 |