Individual
SAI DIWAKAR KUCHIBHOTLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CNP
Contact information
Practice address
8700 SUDLEY RD, MANASSAS, VA 20110-4418
(703) 396-5292
(703) 396-5297
Mailing address
PO BOX 936952, ATLANTA, GA 31193-6952
(703) 396-5292
(703) 396-5297
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024170558
VA
363LA2200X
Adult Health Nurse Practitioner
0024170558
VA
363LA2200X
Adult Health Nurse Practitioner
COA.11893
OH
Other
Enumeration date
10/18/2010
Last updated
02/03/2022
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