Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0024177966 | VA |
NPI | 1023662954 |
---|---|
Provider Name | Mrs. Virgil Charles |
First Address | Hampton, VA 23666-2409 |
Second Address | Hampton, VA 23666-2409 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2019 |
Last Update Date | 29/07/2019 |