| NPI | 1790546661 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | AMANDA WARD Credentialing Specia 757-340-3489 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LA2200X Nurse Practitioner, Adult Health |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2024-01-18 |
| Last Update Date | 2024-01-18 |