Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 0024180239 | VA |
NPI | 1013524891 |
---|---|
Provider Name | Ethan Newham |
First Address | Richmond, VA 23298-5071 |
Second Address | Richmond, VA 23298-5071 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/09/2020 |
Last Update Date | 14/10/2020 |