Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 0102202059 | VA |
NPI | 1083797948 |
---|---|
Provider Name | Kristina Jacquelyn St.clair |
First Address | Portsmouth, VA 23707 |
Second Address | Portsmouth, VA 23708-2197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 22/07/2014 |