Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | 0019006578 | VA |
NPI | 1750500401 |
---|---|
Provider Name | J. Ardenia Gaines |
First Address | Fredericksburg, VA 22406-1028 |
Second Address | Fredericksburg, VA 22406-1028 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2007 |
Last Update Date | 08/07/2007 |