Healthcare Provider Details

I. General information

NPI: 1184338816
Provider Name (Legal Business Name): ALLISON RUESCH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2023
Last Update Date: 07/19/2024
Certification Date: 07/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19465 DEERFIELD AVE STE 408
LANSDOWNE VA
20176-1707
US

IV. Provider business mailing address

19465 DEERFIELD AVE STE 408
LANSDOWNE VA
20176-1707
US

V. Phone/Fax

Practice location:
  • Phone: 703-723-6568
  • Fax:
Mailing address:
  • Phone: 703-723-6568
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185431
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number0024185431
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: