| NPI | 1376250183 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DEBRA YOUNG Manager 910-488-2120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QV0200X Clinic/Center, VA |
| Additional Taxonomies | 363LP2300X Nurse Practitioner, Primary Care |
| Enumeration Date | 2022-11-01 |
| Last Update Date | 2022-11-02 |