Organization
MEDILUXE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACQUELYN KATZ DNP, FNP-C (LEAD PROVIDER/OWNER)
(555) 555-5555
Entity
Organization
Contact information
Practice address
19349 DIAMOND LAKE DR, LEESBURG, VA 20176-6596
(571) 283-1124
Mailing address
19349 DIAMOND LAKE DR, LEESBURG, VA 20176-6596
(555) 555-5555
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
10/02/2019
Last updated
10/30/2019
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