Provider Demographics
NPI:1629656749
Name:SHEN, KATIE (BSN RN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:SHEN
Suffix:
Gender:F
Credentials:BSN RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10880 MIMOSA PL
Mailing Address - Street 2:
Mailing Address - City:OAKTON
Mailing Address - State:VA
Mailing Address - Zip Code:22124-2427
Mailing Address - Country:US
Mailing Address - Phone:571-208-4478
Mailing Address - Fax:
Practice Address - Street 1:10880 MIMOSA PL
Practice Address - Street 2:
Practice Address - City:OAKTON
Practice Address - State:VA
Practice Address - Zip Code:22124-2427
Practice Address - Country:US
Practice Address - Phone:571-208-4478
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2023-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0001306611163WW0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WW0101XNursing Service ProvidersRegistered NurseWomen's Health Care, Ambulatory
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program