Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 0024181370 | VA |
NPI | 1225612112 |
---|---|
Provider Name | Candace James |
First Address | Virginia Beach, VA 23456-7789 |
Second Address | Norfolk, VA 23507-1971 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2021 |
Last Update Date | 07/05/2021 |