| Name | Value |
|---|---|
| PROVIDER TYPE | Nursing Service |
| CLASSIFICATION | Other Nursing Services (Non-R.N.s) |
| AREA OF SPECIALIZATION | Christian Science Nurse |
| STATUS | Inactive |
| DATE INACTIVATED | 1998-10-20 00:00:00 |
| VA CODE | V070801 |
| reserved | P669 |
| INDIVIDUAL/NON | INDIVIDUAL |
| MASTER ENTRY FOR VUID | YES |
| VUID | 5252843 |
| EFFECTIVE DATE/TIME |
|