Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 0024175131 | VA |
NPI | 1003326315 |
---|---|
Provider Name | Mr. Adam Jeffrey Arnold |
First Address | Gladstone, VA 24553-3624 |
Second Address | New Canton, VA 23123-2234 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2017 |
Last Update Date | 02/10/2017 |