1093738411 NPI number — MS. ANGANETTE LINDA NESSELRODT-HOUSDEN RN, MSN, FNP

Table of content: MS. ANGANETTE LINDA NESSELRODT-HOUSDEN RN, MSN, FNP (NPI 1093738411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093738411 NPI number — MS. ANGANETTE LINDA NESSELRODT-HOUSDEN RN, MSN, FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NESSELRODT-HOUSDEN
Provider First Name:
ANGANETTE
Provider Middle Name:
LINDA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN, FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
NESSELRODT
Provider Other First Name:
ANGANETTE
Provider Other Middle Name:
LINDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1093738411
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 CAMPUS BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINCHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22601-2888
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-536-5100
Provider Business Mailing Address Fax Number:
540-536-0235

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
135 MEMORIAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LURAY
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22835-1016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-743-2887
Provider Business Practice Location Address Fax Number:
540-743-1288
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024166296 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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