Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0024177778 | VA |
NPI | 1164074803 |
---|---|
Provider Name | Mr. Christopher Carter |
First Address | Richmond, VA 23249-0001 |
Second Address | Richmond, VA 23249-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2019 |
Last Update Date | 12/07/2019 |