Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 0024174864 | VA |
NPI | 1073043444 |
---|---|
Provider Name | Kristin Dale |
First Address | Harrisonburg, VA 22801-8758 |
Second Address | Staunton, VA 24402-2500 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/06/2017 |
Last Update Date | 18/06/2017 |