Healthcare Provider Details

I. General information

NPI: 1619045663
Provider Name (Legal Business Name): FLORA PAUL FENCHEL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 PARKEAST CIR # 200
CHANTILLY VA
20151-2295
US

IV. Provider business mailing address

2908 ROBIN GLEN CT
HERNDON VA
20171-2329
US

V. Phone/Fax

Practice location:
  • Phone: 703-968-4008
  • Fax: 703-435-1961
Mailing address:
  • Phone: 703-437-0519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0001106035
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: