Individual
JUDITH STEWART WACKENHUT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
545 TRIADELPHIA WAY, ALEXANDRIA, VA 22312-3496
(205) 437-8870
(205) 437-8875
Mailing address
545 TRIADELPHIA WAY, ALEXANDRIA, VA 22312-3496
(205) 437-8870
(205) 437-8875
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024087869
VA
Other
Enumeration date
11/26/2016
Last updated
11/26/2016
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