Healthcare Provider Details

I. General information

NPI: 1871563460
Provider Name (Legal Business Name): PATRICIA MCDONALD WOMEN'S HEALTH NP/CE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 12/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4308 EVERGREEN LN STE F
ANNANDALE VA
22003
US

IV. Provider business mailing address

4308 EVERGREEN LN STE F
ANNANDALE VA
22003
US

V. Phone/Fax

Practice location:
  • Phone: 703-658-8282
  • Fax: 703-658-8283
Mailing address:
  • Phone: 703-658-8282
  • Fax: 703-658-8283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024176212
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number0024176212
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number0024176212
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001279202
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: