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General NPI Number Information
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NPI Number | 1518099027
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Entity Type | Individual
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Provider Name | STEPHANIE CARROLL BERNARD PA-C, RD
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Gender | Female
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Dates
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Enumeration Date | 03/10/2007
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Last Update Date | 05/04/2017
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Provider Practice Location Address
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Address Line | 44160 SCHOLAR PLZ
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City | LEESBURG
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State | VA
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Zip | 20176-3459
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Country | US
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Telephone | 540-542-6546
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Fax |
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Provider Business Mailing Address
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Address Line | 20893 FOWLERS MILL CIR
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City | ASHBURN
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State | VA
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Zip | 20147-4810
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Country | US
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Telephone | 617-571-7194
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110005158
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License Number State | VA
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