Organization
ALLIANCE FAMILY PRACTICE, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ALFREDA BOOKER (BILLING MANAGER)
(804) 323-5575
Entity
Organization
Contact information
Practice address
3333 S CRATER RD, SUITE 3A, PETERSBURG, VA 23805-9276
(804) 733-3438
(804) 733-7424
Mailing address
3333 S CRATER RD, SUITE 3A, PETERSBURG, VA 23805-9276
(804) 733-3438
(804) 733-7424
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0024131004
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0024131004
STATE ID
VA
Enumeration date
07/15/2006
Last updated
08/08/2007
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