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General NPI Number Information
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NPI Number | 1851655443
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Entity Type | Individual
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Provider Name | CHRISTINE ROACH-BIRDEN NP
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Gender | Female
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Dates
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Enumeration Date | 06/27/2012
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Last Update Date | 01/22/2015
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Provider Practice Location Address
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Address Line | 4800 FILLMORE AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-5070
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Country | US
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Telephone | 703-824-1283
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Fax |
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Provider Business Mailing Address
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Address Line | 6708 DOANE AVE
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City | SPRINGFIELD
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State | VA
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Zip | 22152-3011
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Country | US
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Telephone | 703-505-4807
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024164115
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License Number State | VA
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