1164431987 NPI number — MISS KAREN MARIE WOOD ANP

Table of content: MISS KAREN MARIE WOOD ANP (NPI 1164431987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164431987 NPI number — MISS KAREN MARIE WOOD ANP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WOOD
Provider First Name:
KAREN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
ANP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PAPPENFUS
Provider Other First Name:
KAREN
Provider Other Middle Name:
MARIE
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:
1164431987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8502 BRANDING IRON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK HILL
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20171
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-318-3265
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11975 BOWMAN TOWNE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RESTON
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20190-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-323-1417
Provider Business Practice Location Address Fax Number:
703-437-1975
Provider Enumeration Date:
08/08/2006

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: 363L00000X , with the licence number:  0017000240 , 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)