Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0024176566 | VA |
NPI | 1023596947 |
---|---|
Provider Name | Anthony Vincent Santalucia |
First Address | Richmond, VA 23226-2442 |
Second Address | Richmond, VA 23226-2442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2018 |
Last Update Date | 26/07/2019 |