Individual
MRS. KRISTIN VIDWANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
171 ELDEN ST STE 160, HERNDON, VA 20170-4834
(703) 373-0040
Mailing address
7303 PIMMIT CT, FALLS CHURCH, VA 22043-1409
(703) 863-4270
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002272
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110002272
LICENSE
VA
Enumeration date
10/11/2006
Last updated
10/09/2025
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