Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 0024164278 | VA |
NPI | 1114137593 |
---|---|
Provider Name | Marilyn Sue Kraje |
First Address | Lynchburg, VA 24504-2306 |
Second Address | Lynchburg, VA 24504-2306 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |