Healthcare Provider Details

I. General information

NPI: 1992949887
Provider Name (Legal Business Name): KATHERINE MARGARET M. WENDELL R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2009
Last Update Date: 04/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11609 DEER FOREST RD
RESTON VA
20194-1104
US

IV. Provider business mailing address

11609 DEER FOREST RD
RESTON VA
20194-1104
US

V. Phone/Fax

Practice location:
  • Phone: 703-437-1943
  • Fax:
Mailing address:
  • Phone: 703-437-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number0001203352
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: