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General NPI Number Information
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NPI Number | 1609258946
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Entity Type | Individual
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Provider Name | MARY JUNE C SO
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Gender | Female
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Dates
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Enumeration Date | 06/23/2015
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3307
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Country | US
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Telephone | 703-776-3650
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Fax |
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Provider Business Mailing Address
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Address Line | 1307 VINCENT PL
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City | MC LEAN
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State | VA
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Zip | 22101-3680
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001220246
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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 | 1017196
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License Number State | DC
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AC002763
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License Number State | MD
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024172718
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License Number State | VA
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