Healthcare Provider Details

I. General information

NPI: 1942598685
Provider Name (Legal Business Name): STEPHANIE RUTH-STRANGE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 07/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19415 DEERFIELD AVE SUITE 213
LANSDOWNE VA
20176-8452
US

IV. Provider business mailing address

19415 DEERFIELD AVE SUITE 213
LANSDOWNE VA
20176-8452
US

V. Phone/Fax

Practice location:
  • Phone: 703-729-9220
  • Fax: 703-858-3529
Mailing address:
  • Phone: 703-729-9220
  • Fax: 703-858-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169477
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: