Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 0101238091 | VA |
NPI | 1821017088 |
---|---|
Provider Name | Dr. Heidi Amanda Kulberg |
First Address | Virginia Beach, VA 23455-6447 |
Second Address | Virginia Beach, VA 23455-6447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 23/07/2020 |