Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024173642 | VA |
NPI | 1003266099 |
---|---|
Provider Name | Dianne White |
First Address | Lynchburg, VA 24502-2889 |
Second Address | Lynchburg, VA 24502-2889 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2016 |
Last Update Date | 21/06/2016 |