| NPI | 1871775882 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LISA MICHELLE BRICKER Ed 540-236-3683 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: VA 0024129529) |
| Enumeration Date | 2007-11-30 |
| Last Update Date | 2023-08-29 |