| NPI | 1720616295 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ANGELA TUCKER ANDERSON Owner/Nurse Practitioner 804-416-6673 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QP2300X Clinic/Center, Primary Care |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2020-03-31 |
| Last Update Date | 2023-04-17 |