Individual
KIM VANESSA IVY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RRT
Contact information
Practice address
100 EMANCIPATION DR, HAMPTON, VA 23667-0001
(757) 722-9961
Mailing address
3740 ROBIN HOOD RD, NORFOLK, VA 23513-4166
(757) 722-9961
Taxonomy
Speciality
Code
Description
License number
State
227900000X
Registered Respiratory Therapist
Primary
0117004230
VA
Other
Enumeration date
06/29/2006
Last updated
07/08/2007
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