Basic Information
Provider Information | |||||||||
NPI: | 1023200250 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ELDER | ||||||||
FirstName: | CATHERINE | ||||||||
MiddleName: | COLE | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | PALMINTIER | ||||||||
OtherFirstName: | CATHERINE | ||||||||
OtherMiddleName: | MAY COLE | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 6010 GREELEY BLVD | ||||||||
Address2: |   | ||||||||
City: | SPRINGFIELD | ||||||||
State: | VA | ||||||||
PostalCode: | 221521209 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7036449779 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 13525 DULLES TECHNOLOGY DR | ||||||||
Address2: |   | ||||||||
City: | HERNDON | ||||||||
State: | VA | ||||||||
PostalCode: | 201713413 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7034818160 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/12/2007 | ||||||||
LastUpdateDate: | 01/14/2012 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | 0024167108 | VA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health |
No ID Information.