Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | RN047729 | GA |
NPI | 1013916709 |
---|---|
Provider Name | Ms. Vickie Fox |
First Address | Atlanta, GA 30328-5382 |
Second Address | Atlanta, GA 30328-5382 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2005 |
Last Update Date | 19/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000585505A | (05) | GA |
000585505B | (05) | GA |
000585505C | (05) | GA |
000585505E | (05) | GA |
000585505F | (05) | GA |