| NPI | 1861583510 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY PROVENCHER Credentialing Supervisor 540-371-3010 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2025-11-17 |