Healthcare Provider Details

I. General information

NPI: 1194418004
Provider Name (Legal Business Name): MIRWAIS NASARI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2023
Last Update Date: 05/29/2023
Certification Date: 05/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 N GEORGE MASON DR
ARLINGTON VA
22205-3601
US

IV. Provider business mailing address

1635 N GEORGE MASON DR
ARLINGTON VA
22205-3601
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024187159
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: