Provider Demographics
NPI:1669292017
Name:HONSTEIN, HEATHER REBECCA
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:REBECCA
Last Name:HONSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:513 E BELLEFONTE AVE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22301-1200
Mailing Address - Country:US
Mailing Address - Phone:609-575-3190
Mailing Address - Fax:
Practice Address - Street 1:801 N QUINCY ST STE 601
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22203-1729
Practice Address - Country:US
Practice Address - Phone:703-812-4642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-11
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001323410363L00000X
VA0024191515363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner