Healthcare Provider Details

I. General information

NPI: 1407563513
Provider Name (Legal Business Name): ELISE ANN KRUDER CSA, CSFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2022
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

912 WARLANDER DR SW
LEESBURG VA
20175-4386
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4001
  • Fax:
Mailing address:
  • Phone: 703-965-4299
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: