Healthcare Provider Details

I. General information

NPI: 1033226873
Provider Name (Legal Business Name): JOANNE MARIE PORWOLL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY 8901 WISCONSIN AVE, BLDG 19, DECK 5
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

26 S GORDON ST
ALEXANDRIA VA
22304-4930
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-5165
  • Fax: 301-295-5170
Mailing address:
  • Phone: 703-521-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN966468
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: