Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 0024170443 | VA |
NPI | 1962768481 |
---|---|
Provider Name | James Ryan Robertson |
First Address | Martinsville, VA 24112-3747 |
Second Address | Martinsville, VA 24112-3747 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2012 |
Last Update Date | 17/03/2016 |