| NPI | 1780069906 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STACY KUCHARCZK Owner 757-944-1234 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0200X Nurse Practitioner, Pediatrics (Licence: VA 0024142347) |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2015-07-29 |