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NPI Code Detail

MEDICARE: ANDREA D STALLWORTH-VERSTRAETE FNP

MEDICARE: ANDREA D STALLWORTH-VERSTRAETE FNP
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
1363LF0000XFamily Nurse PractitionerRN963727DC

General Provider Information

NPI Number : 1134316045
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA D STALLWORTH-VERSTRAETE FNP
Provider Business Mailing Address
First Line : 210 T ST NW
Second Line :
City : WASHINGTON
State : DC
Zip : 20001-1841
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 845 BLADENSBURG RD NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20002-3927
Country : US
Telephone Number : 202-397-2600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/25/2007
Last Update Date : 10/25/2017

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