Healthcare Provider Details

I. General information

NPI: 1316928302
Provider Name (Legal Business Name): GLORIA R DEAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9501 FARRELL RD
FORT BELVOIR VA
22060-5901
US

IV. Provider business mailing address

8643 GATESHEAD RD
ALEXANDRIA VA
22309-4042
US

V. Phone/Fax

Practice location:
  • Phone: 703-805-0061
  • Fax: 703-805-0049
Mailing address:
  • Phone: 703-805-0061
  • Fax: 703-805-0049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number0001063797
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: