Provider Demographics
NPI:1801643770
Name:BASQUILL-WHITE, KATHERINE AMANDA
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:AMANDA
Last Name:BASQUILL-WHITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:AMANDA
Other - Last Name:VIROSTEK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2514 S ARLINGTON MILL DR APT B
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-4038
Mailing Address - Country:US
Mailing Address - Phone:407-401-2913
Mailing Address - Fax:
Practice Address - Street 1:4301 JONES BRIDGE RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4799
Practice Address - Country:US
Practice Address - Phone:407-401-2913
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program