Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LW0102X | Nurse Practitioner - Women's Health | 0024079274 | VA |
NPI | 1053580597 |
---|---|
Provider Name | Mrs. Carola (none) Bruflat |
First Address | Vienna, VA 22182-3336 |
Second Address | Fairfax, VA 22031-4625 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2008 |
Last Update Date | 28/02/2008 |