Provider Demographics
NPI:1619630407
Name:HOUSE, SANDRA A (NP)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:HOUSE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 SPRING RUN RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:VA
Mailing Address - Zip Code:20187-5861
Mailing Address - Country:US
Mailing Address - Phone:703-955-6174
Mailing Address - Fax:
Practice Address - Street 1:3580 JOSEPH SIEWICK DR STE 401
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1764
Practice Address - Country:US
Practice Address - Phone:703-391-4140
Practice Address - Fax:703-391-4148
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182231164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse