Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | 0024171988 | VA |
NPI | 1023419900 |
---|---|
Provider Name | Cathleen Scully |
First Address | Mc Lean, VA 22101-2903 |
Second Address | Alexandria, VA 22310-3251 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/09/2014 |
Last Update Date | 10/09/2014 |