Provider Demographics
NPI:1841546983
Name:WITKOWSKI, KATHLEEN ELIZABETH (CRNP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:ELIZABETH
Last Name:WITKOWSKI
Suffix:
Gender:F
Credentials:CRNP
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Mailing Address - Street 1:3040 WILLIAMS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:571-350-8400
Mailing Address - Fax:703-940-8697
Practice Address - Street 1:1100 N GLEBE RD STE 1600
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22201-5798
Practice Address - Country:US
Practice Address - Phone:571-350-8400
Practice Address - Fax:703-528-0338
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2024-07-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDR150206363LA2200X, 163WX0200X
VA0024170235363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WX0200XNursing Service ProvidersRegistered NurseOncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841546983Medicaid
VA489920ZAN3Medicare PIN