Healthcare Provider Details

I. General information

NPI: 1639406317
Provider Name (Legal Business Name): COLETTE T KNUDSEN RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 RICHMOND HWY STE 301
ALEXANDRIA VA
22309-2344
US

IV. Provider business mailing address

8350 RICHMOND HWY STE 301
ALEXANDRIA VA
22309-2344
US

V. Phone/Fax

Practice location:
  • Phone: 703-704-7082
  • Fax:
Mailing address:
  • Phone: 703-704-7082
  • Fax: 703-704-6679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024173673
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number0001098727
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: