Basic Information
Provider Information
NPI: 1700352382
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HONG
FirstName: CAROLINE
MiddleName: ERI
NamePrefix:  
NameSuffix:  
Credential: NP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 5404 FISHERS HILL WAY
Address2:  
City: HAYMARKET
State: VA
PostalCode: 201694528
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 3800 RESERVOIR RD NW
Address2:  
City: WASHINGTON
State: DC
PostalCode: 200072113
CountryCode: US
TelephoneNumber: 2024442000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/22/2018
LastUpdateDate: 10/22/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LX0106XRN1050274DCY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerOccupational Health

No ID Information.


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