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General NPI Number Information
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NPI Number | 1649687054
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Entity Type | Organization
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Legal Business Name | INDEPENDENCE PSYCHIATRIC SERVICES
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Dates
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Enumeration Date | 07/17/2014
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Last Update Date | 07/17/2014
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Provider Practice Location Address
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Address Line | 7544 GARDNER PARK DR
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City | GAINESVILLE
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State | VA
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Zip | 20155-3414
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Country | US
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Telephone | 919-645-8435
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Fax | 877-416-0196
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Provider Business Mailing Address
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Address Line | 7544 GARDNER PARK DR
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City | GAINESVILLE
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State | VA
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Zip | 20155-3414
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Country | US
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Telephone | 919-645-8435
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Fax | 877-416-0196
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Authorized Official
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Title or Position | OWNER
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Name | JANE Y HWANG
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Credential | FAMILY PSYCH NP
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Telephone | 919-645-8435
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024168508
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License Number State | VA
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