MEDICARE: YASMIN UNDELAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AC004783	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	NP49342	DC
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024126450	VA

General Provider Information

NPI Number	:	1376505073
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YASMIN UNDELAND

Provider Business Mailing Address
First Line	:	4320 SEMINARY RD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22304-1535
Country	:	US
Telephone Number	:	703-504-3069
Fax Number	:

Provider Business Practice Location Address
First Line	:	2501 N GLEBE RD STE 303
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22207-3558
Country	:	US
Telephone Number	:	703-841-1290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	05/07/2025

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Directions to “ YASMIN UNDELAND ” Practice Location

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