Healthcare Provider Details

I. General information

NPI: 1962520411
Provider Name (Legal Business Name): KATHERINE TREFZGER BAKER CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7915 LAKE MANASSAS DR STE 102
GAINESVILLE VA
20155-3259
US

IV. Provider business mailing address

7915 LAKE MANASSAS DR STE 102
GAINESVILLE VA
20155-3259
US

V. Phone/Fax

Practice location:
  • Phone: 703-754-4101
  • Fax: 703-754-1105
Mailing address:
  • Phone: 703-754-4101
  • Fax: 703-754-1105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0001114394
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: