Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Family |
363LF0000X | 50 | Nurse Practitioner |
| NPI Number | 1710425368 |
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| LBN Legal business name | 1 TEAM LLC TAZEWELL | ||||
| Authorized official | CHARLES DOTY - (PRESIDENT) | ||||
| Entity | Organization | ||||
| Organization subpart 1 | No | ||||
| Enumeration date | 02/03/2017 | ||||
| Last updated | 02/03/2017 - About 9 years ago | ||||
| Identifiers |
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