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CATHERINE GRACE ENGIBOUS HOLDER PA-C

>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1790004844

Individual Registrant:
 CATHERINE GRACE ENGIBOUS HOLDER PA-C
Gender: F
Not Sole Proprietor

Location and contact information for practice:
2710 PROSPERITY AVE STE 200  FAIRFAX, VA 22031-4358 US
Tel: 703-280-2841  Fax: 703-280-4773

Contact information for business:
7036 QUANDER RD  ALEXANDRIA, VA 22307-1612 US
Tel: 907-240-2084  Fax: --

Registration Information:
NPI: 1790004844
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
WAPA60511351
N363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
N363AM0700XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
WAPA60511351
Y363AS0400XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
PA60511351

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
PTANK16367601
MDA0380AK05




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