Individual
MRS. THERESA MCCORMACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PNP
Contact information
Practice address
2035 WATERSIDE RD, SUITE 105, PRINCE GEORGE, VA 23875-1265
(804) 520-0002
(804) 520-2259
Mailing address
2035 WATERSIDE RD, SUITE 105, PRINCE GEORGE, VA 23875-1265
(804) 520-0002
(804) 520-2259
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024165150
VA
Other
Enumeration date
03/12/2016
Last updated
03/12/2016
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