MEDICARE: MRS. MAUREEN HABERMAN VON BREDOW NP

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	0024164075	VA

General Provider Information

NPI Number	:	1972523785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MAUREEN HABERMAN VON BREDOW NP

Provider Business Mailing Address
First Line	:	2217 LOVEDALE LN
Second Line	:	APPARTMENT J
City	:	RESTON
State	:	VA
Zip	:	20191-2360
Country	:	US
Telephone Number	:	703-993-2833
Fax Number	:	703-993-4365

Provider Business Practice Location Address
First Line	:	4400 UNIVERSITY DR
Second Line	:	MS 2D3
City	:	FAIRFAX
State	:	VA
Zip	:	22030-4422
Country	:	US
Telephone Number	:	703-993-2833
Fax Number	:	703-993-4365

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

Provider Enumeration Date	:	07/21/2006
Last Update Date	:	03/09/2015

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