Healthcare Provider Details

I. General information

NPI: 1972188076
Provider Name (Legal Business Name): LINDA WILEY DICOLA AARN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8323 EDEN DR
KING GEORGE VA
22485-4130
US

IV. Provider business mailing address

9653 PAMUNKEY DR
KING GEORGE VA
22485-3645
US

V. Phone/Fax

Practice location:
  • Phone: 540-775-7187
  • Fax:
Mailing address:
  • Phone: 703-408-6261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License Number0001131739
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: