Individual
MRS. KOMKWUAN PHOLTAVEE PARUCHABUTR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
WHNP-BC, FNP-BC, CNM
Contact information
Practice address
9600 DEWITT LOOP, FORT BELVOIR, VA 22060
(703) 424-5112
Mailing address
103 PATRICK ST SW, VIENNA, VA 22180-6740
(703) 424-5112
Taxonomy
Speciality
Code
Description
License number
State
163WW0101X
Ambulatory Women's Health Care Registered Nurse
207275
NC
367A00000X
Advanced Practice Midwife
Primary
—
—
Other
Enumeration date
12/01/2010
Last updated
05/10/2021
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