Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 0024175658 | VA |
N | 363L00000X | Nurse Practitioner | APRN99520 | WV |
N | 363LA2200X | Nurse Practitioner - Adult Health | 0024175658 | VA |
Y | 363LP2300X | Nurse Practitioner - Primary Care | 0024175658 | VA |
NPI | 1063926988 |
---|---|
Provider Name | Eric Langdon Mcbride |
First Address | Winchester, VA 22601-2808 |
Second Address | Winchester, VA 22601-2808 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/11/2017 |
Last Update Date | 08/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
MM4975439 | DEA (01) | WV |