Healthcare Provider Details

I. General information

NPI: 1174270227
Provider Name (Legal Business Name): KIRSTEN FULOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2022
Last Update Date: 03/08/2022
Certification Date: 03/08/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13135 LEE JACKSON MEMORIAL HWY STE 301
FAIRFAX VA
22033-1909
US

IV. Provider business mailing address

13135 LEE JACKSON MEMORIAL HWY STE 301
FAIRFAX VA
22033-1909
US

V. Phone/Fax

Practice location:
  • Phone: 703-264-7801
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024183507
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: