Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1215417001 |
---|---|
Provider Name | Mrs. Takenya Norfus |
First Address | Suffolk, VA 23435-2552 |
Second Address | Suffolk, VA 23435-2552 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2018 |
Last Update Date | 21/08/2018 |