| NPI | 1629699913 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRACY L ZIKES Authorized Official President 540-392-3699 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LG0600X Nurse Practitioner, Gerontology |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| 363LA2200X Nurse Practitioner, Adult Health | |
| Enumeration Date | 2020-04-28 |
| Last Update Date | 2023-03-07 |