Provider Information for 1447877204
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DIERA PARHAMCARRUTHERS
Sex: Female
NPI: 1447877204
Last Updated: 2023-03-15
Certification Date: 2023-03-15
Certification Date: 2023-03-15
Details
| Name | Value | ||||||||||||||||||||||||||||
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| NPI | 1447877204 | ||||||||||||||||||||||||||||
| Enumeration Date | 2020-06-28 | ||||||||||||||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||||||||||||||
| Status | Active | ||||||||||||||||||||||||||||
| Mailing Address | 6106 PATRICIAN CT FREDERICKSBURG, VA 22407-8405 United States Phone: 540-467-7497 | Fax: | ||||||||||||||||||||||||||||
| Primary Practice Address | 2769 RICHMOND HWY STE 111-1155 STAFFORD, VA 22554-8325 United States Phone: 540-467-7497 | Fax: | ||||||||||||||||||||||||||||
| Secondary Practice Address(es) | 4532 PLANK RD | ||||||||||||||||||||||||||||
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