Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 0024171980 | VA |
NPI | 1003246695 |
---|---|
Provider Name | Leana Thorpe |
First Address | Newport News, VA 23601-1318 |
Second Address | Newport News, VA 23602-2017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/11/2013 |
Last Update Date | 11/06/2021 |