Basic Information
| Provider Information | |||||||||
| NPI: | 1336327899 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PALACIO | ||||||||
| FirstName: | NATALEE | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 46090 LAKE CENTER PLZ | ||||||||
| Address2: | STE 102 | ||||||||
| City: | STERLING | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201655876 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034211700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15225 SHADY GROVE RD | ||||||||
| Address2: | STE 102 | ||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503254 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3013300661 | ||||||||
| FaxNumber: | 3019776940 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/07/2008 | ||||||||
| LastUpdateDate: | 02/16/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.