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General NPI Number Information
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NPI Number | 1356776017
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Entity Type | Individual
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Provider Name | COLLEEN E. WAHL FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2013
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Last Update Date | 09/12/2013
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Provider Practice Location Address
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Address Line | 10 CENTER DRIVE MSC 1851 BLDG 10 RM 6C 414
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City | BETHESDA
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State | MD
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Zip | 20892-1851
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Country | US
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Telephone | 301-496-0960
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Fax |
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Provider Business Mailing Address
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Address Line | 11725 STONINGTON PL
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City | SILVER SPRING
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State | MD
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Zip | 20902-1639
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Country | US
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Telephone | 240-328-9345
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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 | R136242
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License Number State | MD
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