Healthcare Provider Details

I. General information

NPI: 1083154371
Provider Name (Legal Business Name): KATHERINE MAUREEN HEROLD NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2017
Last Update Date: 03/08/2017
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

11110 ROCK GARDEN DR
FAIRFAX VA
22030-4935
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-6020
  • Fax:
Mailing address:
  • Phone: 703-447-9226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License Number0024174642
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: