| Name | Value |
|---|---|
| PROVIDER TYPE | Technologists, Technicians & Other Technical Service Providers |
| CLASSIFICATION | Radiologic Technologist |
| AREA OF SPECIALIZATION | Vascular-Interventional Technology |
| STATUS | Inactive |
| DATE INACTIVATED | 2018-04-02 00:00:00 |
| VA CODE | V150301 |
| X12 CODE | 2471V0106X |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5255735 |
| EFFECTIVE DATE/TIME |
|