Healthcare Provider Details

I. General information

NPI: 1689648347
Provider Name (Legal Business Name): ANGELA CUSHING JUST CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2006
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3307
US

IV. Provider business mailing address

814 PARK AVE
FALLS CHURCH VA
22046-3101
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-3154
  • Fax:
Mailing address:
  • Phone: 480-861-2803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN115457
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberAP2177
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: