Healthcare Provider Details

I. General information

NPI: 1609353481
Provider Name (Legal Business Name): KATHERINE LYNN VACHALEK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE LYNN VOGT RN

II. Dates (important events)

Enumeration Date: 07/24/2018
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41680 MISS BESSIE DR
LEONARDTOWN MD
20650-2906
US

IV. Provider business mailing address

41680 MISS BESSIE DR
LEONARDTOWN MD
20650-2906
US

V. Phone/Fax

Practice location:
  • Phone: 301-997-0055
  • Fax:
Mailing address:
  • Phone: 301-997-0055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR134649
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: