MEDICARE: MRS. CHANDA R ATHALE CFNP

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	363LF0000X	Family Nurse Practitioner	0024128574	VA

General Provider Information

NPI Number	:	1407858608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CHANDA R ATHALE CFNP

Provider Business Mailing Address
First Line	:	7617 LITTLE RIVER TPKE
Second Line	:	SUITE 710
City	:	ANNANDALE
State	:	VA
Zip	:	22003-2603
Country	:	US
Telephone Number	:	703-941-1732
Fax Number	:	703-941-2108

Provider Business Practice Location Address
First Line	:	7617 LITTLE RIVER TPKE
Second Line	:	STE 710
City	:	ANNANDALE
State	:	VA
Zip	:	22003-2616
Country	:	US
Telephone Number	:	703-941-1732
Fax Number	:	703-941-2108

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	07/16/2008

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