Provider Demographics
NPI:1366448029
Name:REDLING, ELLEN CHRISTINE (RN,CS,MS)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:CHRISTINE
Last Name:REDLING
Suffix:
Gender:F
Credentials:RN,CS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47168 SKY LN
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:VA
Mailing Address - Zip Code:20165-7515
Mailing Address - Country:US
Mailing Address - Phone:703-444-5059
Mailing Address - Fax:703-723-5998
Practice Address - Street 1:44355 PREMIER PLZ
Practice Address - Street 2:SUITE 120
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-5049
Practice Address - Country:US
Practice Address - Phone:703-955-0537
Practice Address - Fax:703-723-5998
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0015000549364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA355608OtherMAMSI
VA256426OtherANTHEM BC/BS
VA55-1060-1Medicaid
VAS45137Medicare UPIN
VA55-1060-1Medicaid