Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0024182445 | VA |
NPI | 1013682681 |
---|---|
Provider Name | Elia Tessera |
First Address | Woodbridge, VA 22193-4113 |
Second Address | Woodbridge, VA 22193-4113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/08/2021 |
Last Update Date | 14/08/2021 |