Healthcare Provider Details

I. General information

NPI: 1588863500
Provider Name (Legal Business Name): CHERYL ANN OETJEN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 01/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 FORESTWOOD LN
MANASSAS VA
20110-4753
US

IV. Provider business mailing address

9430 FORESTWOOD LN
MANASSAS VA
20110-4753
US

V. Phone/Fax

Practice location:
  • Phone: 703-283-6565
  • Fax: 703-365-0332
Mailing address:
  • Phone: 703-283-6565
  • Fax: 703-365-0332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024167436
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: