Healthcare Provider Details

I. General information

NPI: 1841549870
Provider Name (Legal Business Name): VIRGINIA ELAINE KWITKOWSKI ACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CENTER DR RM 12N226
BETHESDA MD
20892-0001
US

IV. Provider business mailing address

10903 NEW HAMPSHIRE BLD. 22, RM 2161
SILVER SPRING MD
20993-0002
US

V. Phone/Fax

Practice location:
  • Phone: 301-796-2318
  • Fax: 301-796-9845
Mailing address:
  • Phone: 301-796-2318
  • Fax: 301-796-9845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR111293
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: