Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 0024171569 | VA |
NPI | 1174949507 |
---|---|
Provider Name | Mrs. Karen Root |
First Address | Charlottesville, VA 22906-9007 |
Second Address | Charlottesville, VA 22908-0816 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/03/2014 |
Last Update Date | 30/10/2018 |