| NPI | 1902149776 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DESI-RAE HALL Delegated Official 757-251-9419 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 363L00000X Nurse Practitioner |
| Enumeration Date | 2013-03-30 |
| Last Update Date | 2020-11-11 |