Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | 0024175101 | VA |
NPI | 1083124648 |
---|---|
Provider Name | Serena Brown |
First Address | Annandale, VA 22003-7347 |
Second Address | Annandale, VA 22003-7347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/10/2017 |
Last Update Date | 18/04/2018 |