Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 0101263940 | VA |
NPI | 1275978017 |
---|---|
Provider Name | Rebecca Ryan Shoemaker |
First Address | Richmond, VA 23298-5051 |
Second Address | Newport News, VA 23606 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2013 |
Last Update Date | 15/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1275978017 | (05) | VA |
1275978017 | DEPT OF LABOR (01) | VA |
670633 | BLUE CROSS BLUE SHIELD (01) | VA |
6731883 | MAMSI (01) | VA |
6731883 | UNITED HEALTHCARE (01) | VA |