Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 0024176586 | VA |
NPI | 1023591971 |
---|---|
Provider Name | Kathryn Anne Wingo |
First Address | Mc Lean, VA 22101-1507 |
Second Address | Mc Lean, VA 22102-3530 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2018 |
Last Update Date | 06/09/2018 |