Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 0024165470 | VA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024165470 | VA |
NPI | 1003027814 |
---|---|
Provider Name | Kathryn Dort |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2007 |
Last Update Date | 03/05/2011 |