MEDICARE: PWNC PC CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101059282	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184707796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PWNC PC CORP

Provider Business Mailing Address
First Line	:	8650 SUDLEY RD
Second Line	:	SUITE 300
City	:	MANASSAS
State	:	VA
Zip	:	20110-4419
Country	:	US
Telephone Number	:	703-369-0600
Fax Number	:	703-369-7487

Provider Business Practice Location Address
First Line	:	8650 SUDLEY RD
Second Line	:	SUITE 300
City	:	MANASSAS
State	:	VA
Zip	:	20110-4419
Country	:	US
Telephone Number	:	703-369-0600
Fax Number	:	703-369-7487

Authorized Official
Title or Position	:	NEURO PRESIDENT
Name	:	DR. YVETTE C SANDOVAL
Credential	:	M.D.
Telephone Number	:	703-369-0600

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	10/03/2011

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Directions to “PWNC PC CORP ” Practice Location

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