Healthcare Provider Details

I. General information

NPI: 1306907712
Provider Name (Legal Business Name): ROSEMARY HELEN HANNIGAN MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3340 WOODBURN RD
ANNANDALE VA
22003-1202
US

IV. Provider business mailing address

3158 CANTRELL LN
FAIRFAX VA
22031-1909
US

V. Phone/Fax

Practice location:
  • Phone: 703-207-7734
  • Fax: 703-289-2764
Mailing address:
  • Phone: 703-385-8602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001072049
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: