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General NPI Number Information
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NPI Number | 1306095104
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Entity Type | Organization
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Legal Business Name | 31 MEDICAL GROUP
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Dates
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Enumeration Date | 09/17/2008
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Last Update Date | 09/17/2008
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Provider Practice Location Address
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Address Line | PSC 103 BOX 3186
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City | APO
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State | AE
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Zip | 09603-0032
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Country | US
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Telephone | 43-430-5038
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 103 BOX 3186
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City | APO
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State | AE
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Zip | 09603-0032
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Country | US
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Telephone | 43-430-5038
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Fax |
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Authorized Official
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Title or Position | NURSE PRACTITIONER
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Name | MRS. PENELOPE FRANKLIN GORSUCH
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Credential | ACNP
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Telephone | 43-430-5038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number | 089304
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License Number State | GA
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