Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 0024173522 | VA |
NPI | 1013364405 |
---|---|
Provider Name | Angela Fields |
First Address | Castlewood, VA 24224-6397 |
Second Address | Castlewood, VA 24224-6397 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/05/2016 |
Last Update Date | 16/05/2016 |