Provider Demographics
NPI:1033226873
Name:PORWOLL, JOANNE MARIE (NP)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:MARIE
Last Name:PORWOLL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 S GORDON ST
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-4930
Mailing Address - Country:US
Mailing Address - Phone:703-521-2181
Mailing Address - Fax:
Practice Address - Street 1:WALTER REED NATIONAL MILITARY
Practice Address - Street 2:8901 WISCONSIN AVE, BLDG 19, DECK 5
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-0001
Practice Address - Country:US
Practice Address - Phone:301-295-5165
Practice Address - Fax:301-295-5170
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN966468363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC0355333 00Medicaid
DC0355333 00Medicaid
DCFP1004112OtherDEA