Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 0024183604 | VA |
NPI | 1003569898 |
---|---|
Provider Name | Archelle Johnson |
First Address | Richmond, VA 23234-1438 |
Second Address | Richmond, VA 23234-1438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2022 |
Last Update Date | 01/02/2022 |