| Name | Value |
|---|---|
| PROVIDER TYPE | Nursing Service Related Providers |
| CLASSIFICATION | Technician |
| AREA OF SPECIALIZATION | Personal Care Attendant |
| STATUS | Inactive |
| DATE INACTIVATED | 2018-04-02 00:00:00 |
| VA CODE | V170600 |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5253053 |
| EFFECTIVE DATE/TIME |
|