Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024165688 | VA |
NPI | 1013091065 |
---|---|
Provider Name | Ms. Mary Beth Horst |
First Address | Hardy, VA 24101-3967 |
Second Address | Hardy, VA 24101-3967 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 28/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010141508 | (05) | VA |
Q41486 | (02) | VA |