Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0300X | Geriatric Medicine | 0116027867 | VA |
N | 207RH0002X | Hospice and Palliative Medicine | 0116027867 | VA |
NPI | 1215215934 |
---|---|
Provider Name | Lakeshia Antoinette Entzminger |
First Address | Gretna, VA 24557 |
Second Address | Gretna, VA 24557-4087 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2011 |
Last Update Date | 06/08/2016 |