Healthcare Provider Details

I. General information

NPI: 1902481237
Provider Name (Legal Business Name): GEORGE MANASAN OLIVAR RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 03/17/2021
Certification Date: 03/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR
ARLINGTON VA
22205-3601
US

IV. Provider business mailing address

7728 BRANDEIS WAY
SPRINGFIELD VA
22153-3406
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0100X
TaxonomyGastroenterology Registered Nurse
License Number0001267117
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: