Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 0101236568 | VA |
NPI | 1023082864 |
---|---|
Provider Name | Ivette Anne Couret |
First Address | Fulton, MD 20759-2694 |
Second Address | Fairfax, VA 22031-2222 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/02/2006 |
Last Update Date | 28/09/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
BC8819368 | DEA (01) | |
STATE LICENSE | 0101236568 (01) | VA |