Individual
CHARLOTTA JORNLID
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3 RIVERSIDE CIR, ROANOKE, VA 24016-4955
(540) 224-5170
(540) 983-8229
Mailing address
117 ELLENFIELD ST STE 101, PROVIDENCE, RI 02905-4541
(401) 444-6779
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
0102207742
VA
207R00000X
Internal Medicine Physician
Primary
DO01353
RI
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/01/2020
Last updated
07/10/2024
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