1164971081 NPI number — GRETCHEN ELIZABETH HOUSEL N.P.-C

Table of content: GRETCHEN ELIZABETH HOUSEL N.P.-C (NPI 1164971081)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164971081 NPI number — GRETCHEN ELIZABETH HOUSEL N.P.-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSEL
Provider First Name:
GRETCHEN
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BOWMAN
Provider Other First Name:
GRETCHEN
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
N.P.-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1164971081
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8505 ARLINGTON BLVD
Provider Second Line Business Mailing Address:
SUITE #320
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-4621
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-641-0500
Provider Business Mailing Address Fax Number:
703-204-9056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5100 WISCONSIN AVE NW STE 401
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20016-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-527-7393
Provider Business Practice Location Address Fax Number:
202-527-7400
Provider Enumeration Date:
10/04/2016

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: 163W00000X , with the licence number:  0001261752 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163W00000X , with the licence number: RN1044832 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: 0024173026 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: RN1044832 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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