Basic Information
Provider Information
NPI: 1275055584
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GITAU
FirstName: EMILY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2235 LANDOVER PL
Address2:  
City: LYNCHBURG
State: VA
PostalCode: 245012193
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 2235 LANDOVER PL
Address2:  
City: LYNCHBURG
State: VA
PostalCode: 245012193
CountryCode: US
TelephoneNumber: 4348478000
FaxNumber:  
Other Information
ProviderEnumerationDate: 07/10/2017
LastUpdateDate: 12/29/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/29/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LP0808X0024175026VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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