Provider Demographics
NPI:1871356303
Name:CLAESSEN-WOMACK, KEIRA JADE
Entity type:Individual
Prefix:
First Name:KEIRA
Middle Name:JADE
Last Name:CLAESSEN-WOMACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42254 TACKROOM TER
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5876
Mailing Address - Country:US
Mailing Address - Phone:703-862-2576
Mailing Address - Fax:
Practice Address - Street 1:42254 TACKROOM TER
Practice Address - Street 2:
Practice Address - City:ALDIE
Practice Address - State:VA
Practice Address - Zip Code:20105-5876
Practice Address - Country:US
Practice Address - Phone:703-862-2576
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001324484163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse