Provider Demographics
NPI: | 1164971081 |
---|---|
Name: | HOUSEL, GRETCHEN ELIZABETH (NP-C) |
Entity Type: | Individual |
Prefix: | |
First Name: | GRETCHEN |
Middle Name: | ELIZABETH |
Last Name: | HOUSEL |
Suffix: | |
Gender: | F |
Credentials: | NP-C |
Other - Prefix: | |
Other - First Name: | GRETCHEN |
Other - Middle Name: | ELIZABETH |
Other - Last Name: | BOWMAN |
Other - Suffix: | |
Other - Last Name Type: | Former Name |
Other - Credentials: | NP-C |
Mailing Address - Street 1: | 8505 ARLINGTON BLVD |
Mailing Address - Street 2: | SUITE #320 |
Mailing Address - City: | FAIRFAX |
Mailing Address - State: | VA |
Mailing Address - Zip Code: | 22031-4621 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 703-641-0500 |
Mailing Address - Fax: | 703-204-9056 |
Practice Address - Street 1: | 5100 WISCONSIN AVE NW STE 401 |
Practice Address - Street 2: | |
Practice Address - City: | WASHINGTON |
Practice Address - State: | DC |
Practice Address - Zip Code: | 20016-4131 |
Practice Address - Country: | US |
Practice Address - Phone: | 202-527-7393 |
Practice Address - Fax: | 202-527-7400 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2016-10-04 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
VA | 0001261752 | 163W00000X |
DC | RN1044832 | 163W00000X, 363LP2300X |
VA | 0024173026 | 363LP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LP2300X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No | 163W00000X | Nursing Service Providers | Registered Nurse |