Healthcare Provider Details

I. General information

NPI: 1194469122
Provider Name (Legal Business Name): MRS. FREDERICK NELSON TURNER II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2022
Last Update Date: 04/26/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 SARATOGA AVE NE APT 4
WASHINGTON DC
20018-1923
US

IV. Provider business mailing address

1417 SARATOGA AVE NE APT 4
WASHINGTON DC
20018-1923
US

V. Phone/Fax

Practice location:
  • Phone: 301-379-2894
  • Fax:
Mailing address:
  • Phone: 301-379-2894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License NumberB60034973
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: