Individual
DESIREE RAQUEL OUTLAW
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1328 E PEMBROKE AVE, HAMPTON, VA 23669-2445
(757) 379-1660
(855) 679-9729
Mailing address
1328 E PEMBROKE AVE, HAMPTON, VA 23669-2445
(757) 379-1660
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024178891
VA
363LF0000X
Family Nurse Practitioner
1292471
VA
363LF0000X
Family Nurse Practitioner
337212
NY
Other
Enumeration date
04/02/2012
Last updated
10/17/2024
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