MEDICARE: CARISSA DEAR NP

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	363L00000X	Nurse Practitioner	0024168631	VA

General Provider Information

NPI Number	:	1609195338
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARISSA DEAR NP

Provider Business Mailing Address
First Line	:	24984 GLASGOW HEIGHTS TER
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-3225
Country	:	US
Telephone Number	:	571-358-7703
Fax Number	:

Provider Business Practice Location Address
First Line	:	24984 GLASGOW HEIGHTS TER
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-3225
Country	:	US
Telephone Number	:	571-358-7703
Fax Number	:

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

Provider Enumeration Date	:	05/20/2010
Last Update Date	:	10/28/2024

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Directions to “ CARISSA DEAR NP” Practice Location

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