Healthcare Provider Details

I. General information

NPI: 1578572509
Provider Name (Legal Business Name): PATTI P DECORTE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 A PROSPERITY AVENUE
FAIRFAX VA
22031-2238
US

IV. Provider business mailing address

2730 B PROSPERITY AVENUE
FAIRFAX VA
22031-2238
US

V. Phone/Fax

Practice location:
  • Phone: 703-289-1410
  • Fax: 703-289-1420
Mailing address:
  • Phone: 703-289-1400
  • Fax: 703-289-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024167016
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: