Healthcare Provider Details

I. General information

NPI: 1942959382
Provider Name (Legal Business Name): MRS. PURNA KALA GHIMIRE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PURNA KALA POUDEL

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7208 DANFORD LN
SPRINGFIELD VA
22152-3514
US

IV. Provider business mailing address

7208 DANFORD LN
SPRINGFIELD VA
22152-3514
US

V. Phone/Fax

Practice location:
  • Phone: 571-492-1011
  • Fax:
Mailing address:
  • Phone: 571-492-1011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN1053151
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: