Healthcare Provider Details

I. General information

NPI: 1386085199
Provider Name (Legal Business Name): KAREN SUE WITHERS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAREN SUE MARTIN RN

II. Dates (important events)

Enumeration Date: 07/09/2013
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4799
US

IV. Provider business mailing address

4301 JONES BRIDGE RD
BETHESDA MD
20814-4799
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-9561
  • Fax:
Mailing address:
  • Phone: 301-295-9561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN-63111
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License NumberRN-63111
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: