1932122025 NPI number — MRS. CHRISTINE CATHERINE STABLEY PA-C

Table of content: DR. JENNIFER ANN HOLMER SU D.D.S. (NPI 1073554291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932122025 NPI number — MRS. CHRISTINE CATHERINE STABLEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
STABLEY
Provider First Name:
CHRISTINE
Provider Middle Name:
CATHERINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COLMAN
Provider Other First Name:
CHRISTINE
Provider Other Middle Name:
CATHERINE
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932122025
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40698 THISTLE GATE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALDIE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20105-2885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
19441 GOLF VISTA PLAZA SUITE 230 & 310
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20176-8272
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-729-3420
Provider Business Practice Location Address Fax Number:
703-729-3422
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: 363AM0700X , with the licence number:  PA9100640 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: 0110006006 , 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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