Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 0024178333 | VA |
NPI | 1063029171 |
---|---|
Provider Name | Laetitia Eya |
First Address | Richmond, VA 23221-3644 |
Second Address | Richmond, VA 23225-4126 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/09/2020 |
Last Update Date | 25/09/2020 |