Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 0126002456 | VA |
Y | 213ES0000X | Sports Medicine | 0126002456 | VA |
NPI | 1194334326 |
---|---|
Provider Name | Sterling Leann Cupp |
First Address | Woodbridge, VA 22191-4035 |
Second Address | Quantico, VA 22134-5109 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2020 |
Last Update Date | 23/07/2020 |