Individual
MS. NICOLE S. GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP
Contact information
Practice address
1830 TOWN CENTER DR, SUITE # 205, RESTON, VA 20190-3292
(703) 435-3636
(703) 435-9145
Mailing address
1830 TOWN CENTER DR, SUITE # 205, RESTON, VA 20190-3292
(703) 435-3636
(703) 435-9145
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024165394
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7793588
—
VA
Enumeration date
04/13/2007
Last updated
05/20/2014
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