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General NPI Number Information
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NPI Number | 1518958545
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Entity Type | Organization
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Legal Business Name | RADER CLINIC
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 05/14/2013
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Provider Practice Location Address
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Address Line | 401 CARPENTER RD
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City | FORT MYER
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State | VA
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Zip | 22211-1009
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Country | US
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Telephone | 703-696-3447
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Fax |
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Provider Business Mailing Address
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Address Line | 401 CARPENTER RD
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City | FORT MYER
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State | VA
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Zip | 22211-1009
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Country | US
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Telephone | 703-696-3447
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | STACY EVA USHER
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Credential | NP
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Telephone | 703-696-3447
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number | 495950
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License Number State | CA
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