Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 0024177709 | VA |
NPI | 1003470063 |
---|---|
Provider Name | Sarah Katharina Jungnitsch |
First Address | Reston, VA 20190-4847 |
Second Address | Reston, VA 20190 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2019 |
Last Update Date | 08/03/2021 |