Individual
MICO S ANCRUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1012 ROBERTS CT, FREDERICKSBURG, VA 22401-4460
(540) 812-5127
Mailing address
1012 ROBERTS CT, FREDERICKSBURG, VA 22401-4460
(540) 812-5127
Taxonomy
Speciality
Code
Description
License number
State
342000000X
Transportation Network Company
Primary
T61826510
VA
342000000X
Transportation Network Company
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Other
Enumeration date
07/17/2024
Last updated
07/17/2024
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