Healthcare Provider Details

I. General information

NPI: 1992807580
Provider Name (Legal Business Name): CATHERENE LOUTRAIL WOOD RN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8119 HOLLAND RD MOUNT VERNON CENTER - PACT
ALEXANDRIA VA
22306-3135
US

IV. Provider business mailing address

4319 OLD MILL RD
ALEXANDRIA VA
22309-3930
US

V. Phone/Fax

Practice location:
  • Phone: 703-799-2762
  • Fax:
Mailing address:
  • Phone: 703-360-2697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001138565
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: