Healthcare Provider Details

I. General information

NPI: 1629755699
Provider Name (Legal Business Name): HOUDA MARIAM KAMOUN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W BRIGHTON AVE
STERLING VA
20164-3915
US

IV. Provider business mailing address

118 W BRIGHTON AVE
STERLING VA
20164-3915
US

V. Phone/Fax

Practice location:
  • Phone: 703-300-2127
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024189300
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number0001252065
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN1034310
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: