Name | Value |
---|---|
PROVIDER TYPE | Other Service |
CLASSIFICATION | Electrologist |
STATUS | Inactive |
DATE INACTIVATED | 1998-10-20 00:00:00 |
VA CODE | V080300 |
reserved | A, |
INDIVIDUAL/NON | INDIVIDUAL |
MASTER ENTRY FOR VUID | YES |
VUID | 5253110 |
EFFECTIVE DATE/TIME |
|