Healthcare Provider Details

I. General information

NPI: 1508317413
Provider Name (Legal Business Name): RASTRIYATA BHANDARI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RASTRIYATA SUBEDI FNP

II. Dates (important events)

Enumeration Date: 10/17/2016
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4376 GERMANNA HWY
LOCUST GROVE VA
22508-2008
US

IV. Provider business mailing address

PO BOX 749112
ATLANTA GA
30374-9112
US

V. Phone/Fax

Practice location:
  • Phone: 540-972-7798
  • Fax:
Mailing address:
  • Phone: 434-295-1000
  • Fax: 303-825-7927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP131709
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberC-RXN.0000259-C-NP
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024186263
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: