Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | RN044251 | GA |
NPI | 1114068889 |
---|---|
Provider Name | Thea Angela Vaden |
First Address | Atlanta, GA 30339 |
Second Address | Athens, GA 30606-2793 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 13/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
RN044251 | GA NURSING LICENSE (01) | GA |