Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024173928 | VA |
NPI | 1003363722 |
---|---|
Provider Name | Debra Vaccaro |
First Address | Williamsburg, VA 23188-2865 |
Second Address | Albuquerque, NM 87109-3356 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2016 |
Last Update Date | 17/09/2020 |