Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 0024183208 | VA |
NPI | 1023777273 |
---|---|
Provider Name | Mrs. Adrianne J Gruner |
First Address | Leesburg, VA 20175-8857 |
Second Address | Leesburg, VA 20176-4420 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2021 |
Last Update Date | 12/01/2022 |