Provider Demographics
NPI:1831935766
Name:ALPHONSO, CAROLINE REBECCA
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:REBECCA
Last Name:ALPHONSO
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 1:8280 WILLOW OAKS CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4518
Mailing Address - Country:US
Mailing Address - Phone:203-788-7864
Mailing Address - Fax:
Practice Address - Street 1:8280 WILLOW OAKS CORPORATE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4518
Practice Address - Country:US
Practice Address - Phone:203-788-7864
Practice Address - Fax:703-448-0591
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-0005252374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide