NPI 1194195834 · live from the CMS NPI Registry
Advanced Practice Adult-Gerontology
Nurse Practitioner, Gerontology in Dublin, VA. National Provider Identifier 1194195834, active.
NPI record
| NPI | 1194195834 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Gerontology 363LG0600X |
| Practice location | 5140 Hatcher Rd, Fairview Home, Dublin, VA 24084 |
| Practice phone | 276-431-4200 |
| Mailing address | 121 Piney View Ln, Mouth Of Wilson, VA 24363 |
| Enumerated | October 6, 2015 |
| Last updated | October 6, 2015 |
| Authorized official | Daniel Spencer, Owner |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Gerontology primary | 363LG0600X | 0017142291 (VA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.