Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0024180791 | VA |
NPI | 1023601598 |
---|---|
Provider Name | Stephanie Diann Sylvester-Johnson |
First Address | Roanoke, VA 24014-2419 |
Second Address | Roanoke, VA 24014-2419 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2021 |
Last Update Date | 16/02/2021 |