Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 0129000059 | VA |
NPI | 1104120393 |
---|---|
Provider Name | Mrs. Parveen Kelly |
First Address | Bristow, VA 20136-2176 |
Second Address | Bristow, VA 20136-2176 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2011 |
Last Update Date | 06/12/2011 |