Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 10728 | TN |
NPI | 1013105840 |
---|---|
Provider Name | Cassandra R Dingus |
First Address | Big Stone Gap, VA 24219-3468 |
Second Address | Big Stone Gap, VA 24219-3468 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2007 |
Last Update Date | 03/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q01682 | (02) |