Healthcare Provider Details

I. General information

NPI: 1346221504
Provider Name (Legal Business Name): GRETA LYNN KRAPOHL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

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

III. Provider practice location address

401 CARPENTER RD
FORT MYER VA
22211-1009
US

IV. Provider business mailing address

5807 IRON WILLOW CT
ALEXANDRIA VA
22310-1760
US

V. Phone/Fax

Practice location:
  • Phone: 703-696-3447
  • Fax: 703-696-3450
Mailing address:
  • Phone: 703-696-3447
  • Fax: 703-696-3450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number4704247916
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: