Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 0017140197 | VA |
NPI | 1023391380 |
---|---|
Provider Name | Krista E. Centric |
First Address | Chesapeake, VA 23320-3871 |
Second Address | Chesapeake, VA 23320-3871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2011 |
Last Update Date | 10/01/2013 |