Healthcare Provider Details

I. General information

NPI: 1720038862
Provider Name (Legal Business Name): KATHLEEN ELIZABETH MARES CANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8109 HINSON FARM RD STE 504
ALEXANDRIA VA
22306-3411
US

IV. Provider business mailing address

7764 ARMISTEAD RD STE 240
LORTON VA
22079-1920
US

V. Phone/Fax

Practice location:
  • Phone: 703-780-2800
  • Fax: 703-780-0461
Mailing address:
  • Phone: 571-359-4000
  • Fax: 703-621-3793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024062894
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: