Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PE0004X | Emergency Medical Services | 00000000 | VA |
NPI | 1114545928 |
---|---|
Provider Name | Raven Matthews |
First Address | Daleville, VA 24083-1159 |
Second Address | Roanoke, VA 24018-8449 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2020 |
Last Update Date | 29/01/2021 |