| Doctor Name: | KRISTEN ANN MANCUSO |
| NPI Number: | 1023071131 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | 0001163882 |
| Business Practice Address: | 3020 Hamaker Ct Suite 400 Fairfax, VA - 220312238 |
| Business Phone Number: | 7038760080 |
| Business Fax Number: | |
| Mailing Address: | 3020 Hamaker Ct, Suite 400 FAIRFAX |
| State: | VA |
| Postal Code: | 220312238 |
| Phone Number: | 7038760080 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WN0002X |
| License Number: | 0001163882 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Neonatal Intensive Care |
| Taxonomy Definition: | |