Provider Demographics
NPI:1497511265
Name:BLISNIUK, KATHERINE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:BLISNIUK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1262 WILD HAWTHORN WAY
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20194-1017
Mailing Address - Country:US
Mailing Address - Phone:352-455-3070
Mailing Address - Fax:
Practice Address - Street 1:1262 WILD HAWTHORN WAY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20194-1017
Practice Address - Country:US
Practice Address - Phone:352-455-3070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189481363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily