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General NPI Number Information
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NPI Number | 1285587378
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Entity Type | Individual
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Provider Name | ELISABETH ANNE BOETTKE NP
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Gender | Female
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 381 ELDEN ST STE 1000
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City | HERNDON
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State | VA
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Zip | 20170-4842
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Country | US
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Telephone | 703-424-4671
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Fax |
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Provider Business Mailing Address
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Address Line | 14622 CROATAN DR
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City | CENTREVILLE
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State | VA
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Zip | 20120-2981
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Country | US
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Telephone | 703-424-4671
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024196642
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001268093
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License Number State | VA
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