Healthcare Provider Details

I. General information

NPI: 1861462301
Provider Name (Legal Business Name): MARIE HEYRANA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING STREER , NW
WASHINGTON DC
20010
US

IV. Provider business mailing address

6116 BANGOR DR
ALEXANDRIA VA
22303-2308
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7000
  • Fax:
Mailing address:
  • Phone: 703-765-6475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN58110
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: