Provider Demographics
NPI:1205326121
Name:FONG, CATHERINE ANNE (RN)
Entity type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ANNE
Last Name:FONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:CATHERINE
Other - Middle Name:ANNE
Other - Last Name:ALLARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:1549 OLD BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-2737
Mailing Address - Country:US
Mailing Address - Phone:703-496-5321
Mailing Address - Fax:703-496-5321
Practice Address - Street 1:480 CENTRAL AVE BLDG 1750
Practice Address - Street 2:
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860-4908
Practice Address - Country:US
Practice Address - Phone:808-473-1880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-16
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN43841163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIRN43841OtherRN LICENSE