Healthcare Provider Details

I. General information

NPI: 1093978546
Provider Name (Legal Business Name): GINA KARLIN HALDEMAN CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2008
Last Update Date: 07/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4660 KENMORE AVE #902
ALEXANDRIA VA
22304-1313
US

IV. Provider business mailing address

8719 BADGER DR
ALEXANDRIA VA
22309-4036
US

V. Phone/Fax

Practice location:
  • Phone: 703-370-4300
  • Fax:
Mailing address:
  • Phone: 703-360-4150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number0017001470
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: