Healthcare Provider Details

I. General information

NPI: 1396850079
Provider Name (Legal Business Name): SARAH HARWOOD DIAL RN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CAMERON GLEN DR SUITE 600
RESTON VA
20190-3363
US

IV. Provider business mailing address

11714 PROVIDENCE CIR UNIT J
RESTON VA
20190-3560
US

V. Phone/Fax

Practice location:
  • Phone: 703-481-4094
  • Fax:
Mailing address:
  • Phone: 703-464-9090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number0001184636
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: