Individual
DIANE GRESSETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3408 BART ST, PORTSMOUTH, VA 23707-3231
(757) 966-5902
(757) 673-6320
Mailing address
3608 ITHACA TRL, SUFFOLK, VA 23435-2218
(757) 871-2242
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16738
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1174898506
—
VA
Enumeration date
09/13/2016
Last updated
09/13/2016
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