Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 0024173548 | VA |
NPI | 1043616741 |
---|---|
Provider Name | Juanita Marie Norwood |
First Address | Portsmouth, VA 23707-0068 |
Second Address | Norfolk, VA 23510-1065 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2014 |
Last Update Date | 03/08/2020 |