Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 0104-000996 | VA |
NPI | 1306988878 |
---|---|
Provider Name | Dr. Julia Eileen Wray |
First Address | Alexandria, VA 22314-3603 |
Second Address | Alexandria, VA 22314-3603 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U35273 | (02) | VA |