Provider Demographics
NPI:1942959382
Name:GHIMIRE, PURNA KALA
Entity Type:Individual
Prefix:MRS
First Name:PURNA
Middle Name:KALA
Last Name:GHIMIRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PURNA
Other - Middle Name:KALA
Other - Last Name:POUDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7208 DANFORD LN
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-3514
Mailing Address - Country:US
Mailing Address - Phone:571-492-1011
Mailing Address - Fax:
Practice Address - Street 1:7208 DANFORD LN
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-3514
Practice Address - Country:US
Practice Address - Phone:571-492-1011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1053151163WX0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WX0200XNursing Service ProvidersRegistered NurseOncologyGroup - Single Specialty