Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0000X | Nurse Practitioner - Neonatal | 0024084339 | VA |
NPI | 1124209713 |
---|---|
Provider Name | Vicky Maddox Brunet |
First Address | Lynchburg, VA 24503-3815 |
Second Address | Lynchburg, VA 24503-2030 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/11/2007 |
Last Update Date | 24/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
54740N | SENTARA (01) | VA |