Provider Demographics
NPI:1548450463
Name:ALDER, MARY BETH (RN , BSN, NP, DNSC)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:ALDER
Suffix:
Gender:F
Credentials:RN , BSN, NP, DNSC
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1140 VARNUM ST NE STE 203
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2153
Mailing Address - Country:US
Mailing Address - Phone:202-525-5175
Mailing Address - Fax:202-450-6088
Practice Address - Street 1:1140 VARNUM ST NE STE 203
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2153
Practice Address - Country:US
Practice Address - Phone:202-525-5175
Practice Address - Fax:202-450-6088
Is Sole Proprietor?:No
Enumeration Date:2007-07-26
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0001096719207RI0200X
DCRN1015562363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease