Basic Information
Provider Information
NPI: 1073110102
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LIMPASUVAN
FirstName: LOURDES
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: NP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 224D CORNWALL STREET, NW
Address2: SUITE 403
City: LEESBURG
State: VA
PostalCode: 201762704
CountryCode: US
TelephoneNumber: 7037376001
FaxNumber: 5712919786
Practice Location
Address1: 211 GIBSON STREET
Address2: SUITE 215
City: LEESBURG
State: VA
PostalCode: 201762115
CountryCode: US
TelephoneNumber: 5717072085
FaxNumber: 5712919196
Other Information
ProviderEnumerationDate: 10/01/2020
LastUpdateDate: 06/30/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
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AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/30/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000X0024182509VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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