Provider Demographics
NPI:1508350224
Name:COLE, NAILEY MARY (RN)
Entity Type:Individual
Prefix:MISS
First Name:NAILEY
Middle Name:MARY
Last Name:COLE
Suffix:
Gender:F
Credentials:RN
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Mailing Address - Street 1:4012 WILLIAMSBURG CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1139
Mailing Address - Country:US
Mailing Address - Phone:703-425-2273
Mailing Address - Fax:703-425-2274
Practice Address - Street 1:4012 WILLIAMSBURG CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-1139
Practice Address - Country:US
Practice Address - Phone:703-425-2273
Practice Address - Fax:703-425-2274
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-16
Last Update Date:2018-06-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VAHCO-15403163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215964200Medicaid