Healthcare Provider Details

I. General information

NPI: 1508905647
Provider Name (Legal Business Name): MARY JANE NELSON APRN BC RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 N GEORGE MASON DRIVE
ARLINGTON VA
22205
US

IV. Provider business mailing address

1138 N UTAH ST
ARLINGTON VA
22201
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-5162
  • Fax: 703-228-5234
Mailing address:
  • Phone: 703-528-4584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0001136555
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: