Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 0401416585 | VA |
Y | 213EG0000X | General Practice | 0401416585 | VA |
NPI | 1003477498 |
---|---|
Provider Name | Taylor Tate Arkema |
First Address | Henrico, VA 23231-3027 |
Second Address | Richmond, VA 23221-1801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/06/2019 |
Last Update Date | 06/08/2019 |