Registry details
Type
Individual
Primary specialty
Nurse Practitioner, Family
Enumerated
Feb 26, 2017
License(s)
SP020776 (PA), 0024174599 (VA)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| LOCATION | 417 BALTIMORE PIKE | Springfield, PA 19064-3810 | 484-470-2600 |
| MAILING | 5000 COX RD | Glen Allen, VA 23060-9263 | 049-685-7008 |
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