Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 0024166600 | VA |
NPI | 1013071018 |
---|---|
Provider Name | Ms. Rene Lynn Ernest |
First Address | Manassas, VA 20109-3110 |
Second Address | Manassas, VA 20110-4425 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 30/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
Q60496 | (02) | NY |