Provider Demographics
NPI:1073064754
Name:NIGHTINGALE, VIENNA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:VIENNA
Middle Name:R
Last Name:NIGHTINGALE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3344 GUNSTON RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2133
Mailing Address - Country:US
Mailing Address - Phone:312-567-0765
Mailing Address - Fax:
Practice Address - Street 1:3344 GUNSTON RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22302-2133
Practice Address - Country:US
Practice Address - Phone:312-567-0765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810005311103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical