Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0101255920 | VA |
NPI | 1003074071 |
---|---|
Provider Name | Dr. Kristin Bresowar |
First Address | Saltville, VA 24370-0729 |
Second Address | Saltville, VA 24370-3112 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/05/2008 |
Last Update Date | 28/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1952434383 | (05) | VA |