Provider Demographics
NPI:1003470063
Name:JUNGNITSCH, SARAH KATHARINA
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:KATHARINA
Last Name:JUNGNITSCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 ORACLE WAY APT 915
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-4847
Mailing Address - Country:US
Mailing Address - Phone:210-612-8610
Mailing Address - Fax:
Practice Address - Street 1:RESTON ANESTHESIA ASSOCIATES
Practice Address - Street 2:11341 SUNSET HILLS ROAD
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190
Practice Address - Country:US
Practice Address - Phone:703-689-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-25
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177709367500000X, 363L00000X
TX809361163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner