Provider Demographics
NPI:1508813411
Name:MANFREDI, CATHERINE M (NP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:M
Last Name:MANFREDI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2901 TELESTAR CT STE 300
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-1263
Mailing Address - Country:US
Mailing Address - Phone:703-591-1688
Mailing Address - Fax:703-591-1445
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:#550
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3219
Practice Address - Country:US
Practice Address - Phone:703-437-5977
Practice Address - Fax:703-478-2475
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2021-08-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166428363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1508813411Medicaid
DCP01236177OtherRAILROAD MEDICARE
VAP00780043OtherRAILROAD MEDICARE
VAP57285Medicare UPIN
DC017540T42Medicare PIN
VAP00780043OtherRAILROAD MEDICARE