| NPI | 1770134967 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | KRYSTAL K LAUER Authorized Official/Owner 804-441-0447 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2019-09-27 |
| Last Update Date | 2019-09-27 |