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General NPI Number Information
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NPI Number | 1619630407
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Entity Type | Individual
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Provider Name | SANDRA A HOUSE NP
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Gender | Female
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Dates
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Enumeration Date | 10/19/2021
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Last Update Date | 12/18/2021
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Provider Practice Location Address
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Address Line | 3580 JOSEPH SIEWICK DR STE 401
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City | FAIRFAX
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State | VA
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Zip | 22033-1764
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Country | US
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Telephone | 703-391-4140
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Fax | 703-391-4148
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Provider Business Mailing Address
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Address Line | 4432 SPRING RUN RD
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City | WARRENTON
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State | VA
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Zip | 20187-5861
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Country | US
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Telephone | 703-955-6174
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 0024182231
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License Number State | VA
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