Individual
NOLA THROWER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
128 GRAYSTONE TRCE, SUFFOLK, VA 23435-3234
(757) 537-7745
Mailing address
128 GRAYSTONE TRCE, SUFFOLK, VA 23435-3234
(757) 537-7745
Taxonomy
Speciality
Code
Description
License number
State
156F00000X
Technician/Technologist
Primary
—
VA
208800000X
Urology Physician
49CERPART40
VA
Other
Enumeration date
04/22/2024
Last updated
04/22/2024
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