Name | Value |
---|---|
PROVIDER TYPE | Nursing Service |
CLASSIFICATION | Nurse Practitioner |
STATUS | Inactive |
DATE INACTIVATED | 1998-10-20 00:00:00 |
VA CODE | V070500 |
reserved | P661 |
INDIVIDUAL/NON | INDIVIDUAL |
MASTER ENTRY FOR VUID | YES |
VUID | 5252810 |
EFFECTIVE DATE/TIME |
|