Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024167161 | VA |
NPI | 1003968884 |
---|---|
Provider Name | Flordeliza Ablao-Chanthavichith |
First Address | Virginia Beach, VA 23452-7327 |
Second Address | Portsmouth, VA 23703-3200 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 26/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1003968884 | (05) | VA |