Individual
JACQUELINE O BRUCE-TAGOE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15816 MEHERRIN WAY, WOODBRIDGE, VA 22191-4264
(703) 919-5815
Mailing address
15816 MEHERRIN WAY, WOODBRIDGE, VA 22191-4264
(703) 919-5815
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002073930
VA
Other
Enumeration date
08/18/2010
Last updated
08/18/2010
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