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NPI Code Detail

MEDICARE: ALTHEA DOUGLAS FNP-BC

MEDICARE: ALTHEA DOUGLAS FNP-BC
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
1363LF0000XFamily Nurse Practitioner95027573CA
2163W00000XRegistered Nurse0001273633VA

General Provider Information

NPI Number : 1598417552
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALTHEA DOUGLAS FNP-BC
Provider Business Mailing Address
First Line : 3259 CATLIN AVE
Second Line :
City : QUANTICO
State : VA
Zip : 22134-5109
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3259 CATLIN AVE
Second Line :
City : QUANTICO
State : VA
Zip : 22134-5109
Country : US
Telephone Number : 703-784-1725
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/21/2022
Last Update Date : 03/15/2026

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Directions to “ ALTHEA DOUGLAS FNP-BC” Practice Location

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