MEDICARE: PRN MEDICAL STAFFERS

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	251J00000X	Nursing Care Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	HCO-09524	OTHER	VA	HOME CARE ORGANIZATION

General Provider Information

NPI Number	:	1871769844
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRN MEDICAL STAFFERS

Provider Business Mailing Address
First Line	:	5409 MAPLEDALE PLZ
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-4526
Country	:	US
Telephone Number	:	703-670-8790
Fax Number	:

Provider Business Practice Location Address
First Line	:	5409 MAPLEDALE PLZ
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-4526
Country	:	US
Telephone Number	:	703-670-8790
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. CHARLOTTE ROYAL
Credential	:
Telephone Number	:	703-680-8790

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	10/21/2008

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