Basic Information
| Provider Information | |||||||||
| NPI: | 1538660220 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED PRACTICE HEALTH CARE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1048 TERRACE DR | ||||||||
| Address2: | |||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544138 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767831827 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Practice Location | |||||||||
| Address1: | 61 YAHWEH RD | ||||||||
| Address2: | |||||||||
| City: | CASTLEWOOD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 242246641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767947868 | ||||||||
| FaxNumber: | 2767832879 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/27/2018 | ||||||||
| LastUpdateDate: | 02/27/2018 | ||||||||
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| AuthorizedOfficialLastName: | WALDRON | ||||||||
| AuthorizedOfficialFirstName: | CANDACE | ||||||||
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| AuthorizedOfficialTitleorPosition: | SOLE MBR | ||||||||
| AuthorizedOfficialTelephone: | 2766986867 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | FNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 001714463 | VA | Y | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.