Provider Demographics
NPI:1326004243
Name:CARGILL, GEORGETTE M (RN-C, ANP)
Entity Type:Individual
Prefix:
First Name:GEORGETTE
Middle Name:M
Last Name:CARGILL
Suffix:
Gender:F
Credentials:RN-C, ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7101 JAHNKE RD
Mailing Address - Street 2:SUITE 550
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-4017
Mailing Address - Country:US
Mailing Address - Phone:804-560-8880
Mailing Address - Fax:804-560-9577
Practice Address - Street 1:7101 JAHNKE RD
Practice Address - Street 2:SUITE 550
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-4017
Practice Address - Country:US
Practice Address - Phone:804-560-8880
Practice Address - Fax:804-560-9577
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024102447363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP15628Medicare UPIN
VA00V522V81Medicare ID - Type Unspecified