Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Primary Care |
261QP2300X |
| NPI # | 1063793826 |
||||
| LBN Legal business name | INTERNAL MEDICINE AND PREVENTIVE CARE, P.C. | ||||
| Authorized official | TRACIE WASHBURN - (NURSE PRACTITIONER) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 09/07/2011 | ||||
| Last updated | 09/07/2011 - About 15 years ago | ||||
| Identifiers |
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