Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | 0103301000 | VA |
N | 222Z00000X | Podiatrist | 0103301000 | VA |
Y | 213ES0131X | Foot Surgery | 0103301000 | VA |
NPI | 1245472364 |
---|---|
Provider Name | Dr. Quyen C Soulsby |
First Address | Wytheville, VA 24382-2078 |
Second Address | Wytheville, VA 24382-2078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2009 |
Last Update Date | 01/03/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9464361 | AETNA (01) | VA |