Healthcare Provider Details

I. General information

NPI: 1669091500
Provider Name (Legal Business Name): MS. KULDEEP KAUR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2020
Last Update Date: 04/10/2020
Certification Date: 04/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14150 PARKEAST CIR STE 200
CHANTILLY VA
20151-4212
US

IV. Provider business mailing address

14150 PARKEAST CIR STE 200
CHANTILLY VA
20151-4212
US

V. Phone/Fax

Practice location:
  • Phone: 703-968-4000
  • Fax:
Mailing address:
  • Phone: 703-968-4000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0001200236
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: