Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3008823 | KY |
NPI | 1003212515 |
---|---|
Provider Name | Diana Spring |
First Address | Chantilly, VA 20151-1647 |
Second Address | Chantilly, VA 20151-1647 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2014 |
Last Update Date | 10/11/2014 |