Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | RN966468 | DC |
NPI | 1033226873 |
---|---|
Provider Name | Joanne Marie Porwoll |
First Address | Alexandria, VA 22304-4930 |
Second Address | Bethesda, MD 20889-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 14/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0355333 00 | (05) | DC |
FP1004112 | DEA (01) | DC |
S86512 | (02) | DC |