Provider Demographics
NPI:1841243094
Name:NGUYEN, KATHERINE H (PA)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:H
Last Name:NGUYEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5127 VERONICA RD
Mailing Address - Street 2:
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20120-6435
Mailing Address - Country:US
Mailing Address - Phone:703-830-7093
Mailing Address - Fax:
Practice Address - Street 1:915 N ST SE BLDG 175
Practice Address - Street 2:WASHINGTON NAVY YARD
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20374-5162
Practice Address - Country:US
Practice Address - Phone:202-433-3132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-001392363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA016190B00Medicare ID - Type Unspecified
VAP82181Medicare UPIN