Provider Demographics
NPI:1922230564
Name:HAN-HAFNER, NANCY M (DPM)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:HAN-HAFNER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:M
Other - Last Name:HAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:11737 BOWMAN GREEN DR
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-3501
Mailing Address - Country:US
Mailing Address - Phone:703-437-6333
Mailing Address - Fax:703-437-7837
Practice Address - Street 1:11737 BOWMAN GREEN DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3501
Practice Address - Country:US
Practice Address - Phone:703-437-6333
Practice Address - Fax:703-437-7837
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-16
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103301003213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery