| NPI | 1841834090 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CARRIE A WALTMAN Authorized Official / Owner 804-402-8633 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2022-09-30 |