Individual
MRS. JACQUELINE BOURASSA MUNDUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
50 IRVING ST NW, DERMATOLOGY DEPARTMENT - VAMC, WASHINGTON, DC 20422-0001
(202) 745-8000
Mailing address
1525 WILSON BLVD STE 125, ARLINGTON, VA 22209-2470
(703) 966-7127
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004669
VA
363A00000X
Physician Assistant
C0005468
MD
Other
Enumeration date
08/14/2014
Last updated
04/08/2021
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