Name | Value |
---|---|
PROVIDER TYPE | Nursing Service Providers |
CLASSIFICATION | Registered Nurse |
AREA OF SPECIALIZATION | Psychiatric/Mental Health, Child & Adolescent |
STATUS | Active |
VA CODE | V070953 |
X12 CODE | 163WP0807X |
INDIVIDUAL/NON | INDIVIDUAL |
MASTER ENTRY FOR VUID | YES |
VUID | 5252978 |
EFFECTIVE DATE/TIME |
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