MEDICARE: MS. KATHLEEN ANNE MALLIARAKIS RN, CNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	0024138992	VA

General Provider Information

NPI Number	:	1053313189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN ANNE MALLIARAKIS RN, CNP

Provider Business Mailing Address
First Line	:	3925 N ABINGDON ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-2919
Country	:	US
Telephone Number	:	703-237-7303
Fax Number	:	703-237-7304

Provider Business Practice Location Address
First Line	:	3925 N ABINGDON ST
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-2919
Country	:	US
Telephone Number	:	703-237-7303
Fax Number	:	703-237-7304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/08/2007

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