Provider Demographics
NPI:1093738411
Name:NESSELRODT-HOUSDEN, ANGANETTE LINDA (RN, MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:ANGANETTE
Middle Name:LINDA
Last Name:NESSELRODT-HOUSDEN
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:ANGANETTE
Other - Middle Name:LINDA
Other - Last Name:NESSELRODT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:220 CAMPUS BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-2888
Mailing Address - Country:US
Mailing Address - Phone:540-536-5100
Mailing Address - Fax:540-536-0235
Practice Address - Street 1:135 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LURAY
Practice Address - State:VA
Practice Address - Zip Code:22835-1016
Practice Address - Country:US
Practice Address - Phone:540-743-2887
Practice Address - Fax:540-743-1288
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010399858Medicaid
VAP00337304OtherRR MEDICARE
VA011443V10Medicare PIN
VAP00337304OtherRR MEDICARE