MEDICARE: MRS. KATHERINE MARGARET M. WENDELL R.N.

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	163WA0400X	Addiction (Substance Use Disorder) Registered Nurse	0001203352	VA

General Provider Information

NPI Number	:	1992949887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KATHERINE MARGARET M. WENDELL R.N.

Provider Business Mailing Address
First Line	:	11609 DEER FOREST RD
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20194-1104
Country	:	US
Telephone Number	:	703-437-1943
Fax Number	:

Provider Business Practice Location Address
First Line	:	11609 DEER FOREST RD
Second Line	:
City	:	RESTON
State	:	VA
Zip	:	20194-1104
Country	:	US
Telephone Number	:	703-437-1943
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2009
Last Update Date	:	04/23/2009

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