Healthcare Provider Details

I. General information

NPI: 1457590432
Provider Name (Legal Business Name): TANYA HELEN DEBOER-CHADWELL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2009
Last Update Date: 02/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 FAIRFAX DR SUITE #2
ARLINGTON VA
22203-1711
US

IV. Provider business mailing address

3800 FAIRFAX DR SUITE #2
ARLINGTON VA
22203-1711
US

V. Phone/Fax

Practice location:
  • Phone: 703-351-5100
  • Fax: 703-351-1445
Mailing address:
  • Phone: 703-351-5100
  • Fax: 703-351-1445

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164410
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: