| NPI | 1528316551 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | EMMA HOLTON Provider Enrollment Coordinator 804-643-2287 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 363LP0200X Nurse Practitioner, Pediatrics |
| 363LA2100X Nurse Practitioner, Acute Care | |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2012-08-23 |
| Last Update Date | 2012-08-23 |