Healthcare Provider Details

I. General information

NPI: 1639149537
Provider Name (Legal Business Name): KATHLEEN LAVERY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW
WASHINGTON DC
20010-2976
US

IV. Provider business mailing address

6874F BRINDLE HEATH WAY
ALEXANDRIA VA
22315-5804
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7000
  • Fax:
Mailing address:
  • Phone: 703-719-0405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN57172
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: