| NPI | 1982592010 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RUSSELL F BRADBURY Manager 804-690-8613 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner Psychiatric/Mental Health |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-06-26 |