Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 0024179096 | VA |
NPI | 1043849938 |
---|---|
Provider Name | Charissa Consuelo Carfrey |
First Address | Winchester, VA 22601 |
Second Address | Winchester, VA 22601-2808 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2020 |
Last Update Date | 21/04/2021 |