MEDICARE: MARY CLARE WISTHOFF L.AC., R.N.

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	163W00000X	Registered Nurse	0001096201	VA
2	171100000X	Acupuncturist	U00346	MD

General Provider Information

NPI Number	:	1639201643
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CLARE WISTHOFF L.AC., R.N.

Provider Business Mailing Address
First Line	:	4755 1ST ST N
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-2645
Country	:	US
Telephone Number	:	703-528-2641
Fax Number	:

Provider Business Practice Location Address
First Line	:	8830 CAMERON CT
Second Line	:	SUITE 501
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-4114
Country	:	US
Telephone Number	:	301-565-2700
Fax Number	:

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

Provider Enumeration Date	:	03/12/2007
Last Update Date	:	09/11/2025

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