Individual
MISS NANCY JO LEAGUE
Active
Sole proprietor
Provider details
NPI number
Gender
F
Contact information
Practice address
9501 FARRELL RD, FORT BELVOIR, VA 22060-5901
(703) 805-0989
Mailing address
159 ANTIQUA PL, EDGEWATER, MD 21037-2768
(410) 798-1753
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
664062
TX
Other
Enumeration date
10/26/2005
Last updated
07/08/2007
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