Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 0024171766 | VA |
NPI | 1023423340 |
---|---|
Provider Name | Laura Riddle |
First Address | Norfolk, VA 23505-4614 |
Second Address | Norfolk, VA 23505-4614 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2014 |
Last Update Date | 23/01/2017 |