Healthcare Provider Details

I. General information

NPI: 1790182111
Provider Name (Legal Business Name): CARYN A. WOMBLE CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2014
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

3273 EAGLE RIDGE DR
WOODBRIDGE VA
22191-6520
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-4363
  • Fax:
Mailing address:
  • Phone: 812-243-6264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR186369
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: