Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 0024174937 | VA |
NPI | 1063930428 |
---|---|
Provider Name | Miss Maria Regina Cunanan |
First Address | Virginia Beach, VA 23454-3211 |
Second Address | Virginia Beach, VA 23454-3002 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2017 |
Last Update Date | 06/09/2017 |