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General NPI Number Information
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NPI Number | 1972736908
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Entity Type | Individual
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Provider Name | KATHERINE FOUNTAIN NILES PA
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Gender | Female
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 08/25/2009
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Provider Practice Location Address
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Address Line | US DEPT OF STATE 2401 E ST NW M/MED/QI, SA-1
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City | WASHINGTON
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State | DC
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Zip | 20522-0001
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Country | US
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Telephone | 202-663-2453
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Fax | 202-663-3247
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Provider Business Mailing Address
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Address Line | 2401 E ST NW US DEPT OF STATE M/MED/QI, SA-1
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City | WASHINGTON
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State | DC
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Zip | 20522-0102
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Country | US
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Telephone | 202-663-2453
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Fax | 202-663-3247
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 5601002401
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License Number State | MI
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