Provider Demographics
NPI:1356817530
Name:ANTHONY-DRESSEL, KATHLEEN NICOLE (NP)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:NICOLE
Last Name:ANTHONY-DRESSEL
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 1:3580 MARTHA CUSTIS DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22302-2001
Mailing Address - Country:US
Mailing Address - Phone:310-876-4088
Mailing Address - Fax:
Practice Address - Street 1:3020 HAMAKER CT STE 502
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2220
Practice Address - Country:US
Practice Address - Phone:703-208-7257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-16
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001272855163W00000X
VA0024176958363LF0000X
DCRN1030113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse