1740346204 NPI number — WALTER REED ARMY HEALTHCARE SYSTEM

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740346204 NPI number — WALTER REED ARMY HEALTHCARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WALTER REED ARMY HEALTHCARE SYSTEM
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740346204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1845 FOXWOOD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20721-4140
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-782-0145
Provider Business Mailing Address Fax Number:
202-782-3087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6900 GEORGIA AVE NW
Provider Second Line Business Practice Location Address:
BLDG 1 RM A-126
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20307-0003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-782-0145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STERLING
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
FAMILY NURSE PRACTITIONER
Authorized Official Telephone Number:
202-782-0145

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  RN084447 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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