Provider Demographics
NPI:1295810117
Name:DEPARTMENT OF STATE
Entity type:Organization
Organization Name:DEPARTMENT OF STATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH PRACTITIONER/FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:CLARA
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIEH
Authorized Official - Suffix:
Authorized Official - Credentials:MSN,APRN-BC
Authorized Official - Phone:202-663-2453
Mailing Address - Street 1:2160 FREETOWN PL
Mailing Address - Street 2:
Mailing Address - City:DULLES
Mailing Address - State:VA
Mailing Address - Zip Code:20189-2160
Mailing Address - Country:US
Mailing Address - Phone:901-388-6651
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF STATE
Practice Address - Street 2:2401 E STREET NW, M/MED/QI, SA-1
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20522-0102
Practice Address - Country:US
Practice Address - Phone:202-663-2453
Practice Address - Fax:202-663-3247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN6695261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service