Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 0024167596 | VA |
NPI | 1023298775 |
---|---|
Provider Name | Helen Karellas Bardis |
First Address | Manassas, VA 20110-4753 |
Second Address | Manassas, VA 20110-4753 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2007 |
Last Update Date | 10/11/2007 |