Individual
MARY EILEEN ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
6100 ARLINGTON BLVD, FALLS CHURCH, VA 22044-2901
(703) 237-8627
Mailing address
5044 EISENHOWER AVE APT 418, ALEXANDRIA, VA 22304-4869
(804) 658-8536
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024182085
VA
Other
Enumeration date
07/13/2021
Last updated
08/26/2021
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