Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | RN181526 | GA |
NPI | 1023474582 |
---|---|
Provider Name | Mrs. Virginia Souris Keating |
First Address | Atlanta, GA 30327-3946 |
Second Address | Atlanta, GA 30327-2882 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2016 |
Last Update Date | 13/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN181526 | PROFESSIONAL LICENSE NP-C (01) | GA |