Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024167100 | VA |
NPI | 1003026287 |
---|---|
Provider Name | Norma Branham |
First Address | Charlottesville, VA 22908-0778 |
Second Address | Charlottesville, VA 22908-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 08/07/2007 |