Healthcare Provider Details

I. General information

NPI: 1003470063
Provider Name (Legal Business Name): SARAH KATHARINA JUNGNITSCH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2019
Last Update Date: 03/08/2021
Certification Date: 03/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RESTON ANESTHESIA ASSOCIATES 11341 SUNSET HILLS ROAD
RESTON VA
20190
US

IV. Provider business mailing address

1897 ORACLE WAY APT 915
RESTON VA
20190-4847
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-9000
  • Fax:
Mailing address:
  • Phone: 210-612-8610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024177709
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number809361
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024177709
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: