Healthcare Provider Details

I. General information

NPI: 1801483953
Provider Name (Legal Business Name): ELIZABETH LOUISE KUSLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8119 HOLLAND RD
ALEXANDRIA VA
22306-3135
US

IV. Provider business mailing address

8701 SUDBURY PL
ALEXANDRIA VA
22309-2566
US

V. Phone/Fax

Practice location:
  • Phone: 703-360-3610
  • Fax:
Mailing address:
  • Phone: 515-509-3883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number109936
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: