Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0024179933 | VA |
NPI | 1376153163 |
---|---|
Provider Name | Miss Maria Rowena Capilitan |
First Address | Portsmouth, VA 23707-3236 |
Second Address | Portsmouth, VA 23707-3236 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2020 |
Last Update Date | 04/02/2021 |