Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024166866 | VA |
NPI | 1003032095 |
---|---|
Provider Name | Dr. Ameanthea Rica Blanco-Knezovich |
First Address | Hampton, VA 23666 |
Second Address | Virginia Beach, VA 23455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/04/2007 |
Last Update Date | 21/11/2016 |