Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 0101056467 | VA |
NPI | 1043275803 |
---|---|
Provider Name | Joann Webber Dervay |
First Address | Va Beach, VA 23462 |
Second Address | Norfolk, VA 23502-3933 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 15/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
6802303 | (05) | VA |
H30266 | (02) |