| NPI | 1629379433 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENISE WILSON NICHOLS Administrator 804-288-2830 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: VA 0001186619) |
| Enumeration Date | 2010-11-10 |
| Last Update Date | 2010-11-10 |