Healthcare Provider Details

I. General information

NPI: 1841243094
Provider Name (Legal Business Name): KATHERINE H NGUYEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N ST SE BLDG 175 WASHINGTON NAVY YARD
WASHINGTON DC
20374-5162
US

IV. Provider business mailing address

5127 VERONICA RD
CENTREVILLE VA
20120-6435
US

V. Phone/Fax

Practice location:
  • Phone: 202-433-3132
  • Fax:
Mailing address:
  • Phone: 703-830-7093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-001392
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: