Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223D0004X | Dentist Anesthesiologist | 0401410463 | VA |
Y | 1223P0221X | Pediatric Dentist | 0401410463 | VA |
NPI | 1144226937 |
---|---|
Provider Name | Dr. Jacqueline M Carney |
First Address | Charlottesville, VA 22911-4662 |
Second Address | Charlottesville, VA 22911-4662 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2005 |
Last Update Date | 09/07/2013 |