Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0024172812 | VA |
NPI | 1639555618 |
---|---|
Provider Name | Christine Siddons |
First Address | Richmond, VA 23249-0001 |
Second Address | Richmond, VA 23249-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2015 |
Last Update Date | 03/08/2015 |