| NPI | 1487011367 |
|---|---|
| Other Name | COMMONWEALTH EXTENDED CARE |
| Entity Type | Organization |
| Authorized Contact | KARISSA L. HACKELTON Medical Director/Phyician/Sharehold 804-285-7425 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024172915) |
| Enumeration Date | 2016-01-22 |
| Last Update Date | 2016-01-22 |