Provider Demographics
NPI:1497516629
Name:SENERCHIA, NAM KYUNG
Entity Type:Individual
Prefix:MRS
First Name:NAM KYUNG
Middle Name:
Last Name:SENERCHIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 SUNRISE VALLEY DR STE 500
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20191-5303
Mailing Address - Country:US
Mailing Address - Phone:703-621-4501
Mailing Address - Fax:
Practice Address - Street 1:11800 SUNRISE VALLEY DR STE 500
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-5303
Practice Address - Country:US
Practice Address - Phone:703-621-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001292101363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner