MEDICARE: SARAH ANNE ZGAINER

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	363LP0200X	Pediatric Nurse Practitioner	NP17330	CA
2	363L00000X	Nurse Practitioner	0024170503	VA

General Provider Information

NPI Number	:	1578762753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ANNE ZGAINER

Provider Business Mailing Address
First Line	:	24801 PINEBROOK RD STE 110
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-4113
Country	:	US
Telephone Number	:	703-772-2500
Fax Number	:	703-327-1850

Provider Business Practice Location Address
First Line	:	24801 PINEBROOK RD STE 110
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-4113
Country	:	US
Telephone Number	:	703-772-2500
Fax Number	:	703-327-1850

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	01/15/2021

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