1356445597 NPI number — MS. STEPHANIE MICHELLE SCHUTTER FNP

Table of content: MS. STEPHANIE MICHELLE SCHUTTER FNP (NPI 1356445597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356445597 NPI number — MS. STEPHANIE MICHELLE SCHUTTER FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHUTTER
Provider First Name:
STEPHANIE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

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:
1356445597
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9896 SOUNDING SHORE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRISTOW
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20136-2589
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-396-7838
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 POND WAY
Provider Second Line Business Practice Location Address:
SUITE 170
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22192-5581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
571-542-4950
Provider Business Practice Location Address Fax Number:
571-285-1160
Provider Enumeration Date:
09/08/2006

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: 363LF0000X , with the licence number:  0024165381 , 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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