Healthcare Provider Details

I. General information

NPI: 1932746377
Provider Name (Legal Business Name): KRISTIN A WULFF FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2019
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 KINGSTOWNE VILLAGE PKWY STE 300
ALEXANDRIA VA
22315-5883
US

IV. Provider business mailing address

224D CORNWALL ST NW STE 403
LEESBURG VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 571-384-6304
  • Fax: 571-384-6309
Mailing address:
  • Phone: 703-737-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178495
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: