Healthcare Provider Details

I. General information

NPI: 1750798146
Provider Name (Legal Business Name): KATHLEEN ANASTASIA ZINICOLA CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN ANASTASIA BANIEWICZ RN, CPNP

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 ROLLING RD STE I / J
SPRINGFIELD VA
22152-2307
US

IV. Provider business mailing address

6230 ROLLING RD STE I / J
SPRINGFIELD VA
22152-2307
US

V. Phone/Fax

Practice location:
  • Phone: 571-665-6460
  • Fax: 571-565-6561
Mailing address:
  • Phone: 571-665-6460
  • Fax: 571-565-6561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024171847
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024171847
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: