Healthcare Provider Details

I. General information

NPI: 1376505073
Provider Name (Legal Business Name): YASMIN UNDELAND
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N GLEBE RD STE 303
ARLINGTON VA
22207-3558
US

IV. Provider business mailing address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

V. Phone/Fax

Practice location:
  • Phone: 703-841-1290
  • Fax:
Mailing address:
  • Phone: 703-504-3069
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC004783
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP49342
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024126450
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: