Healthcare Provider Details

I. General information

NPI: 1164974093
Provider Name (Legal Business Name): JILIAN BIANCHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2016
Last Update Date: 02/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 N GEORGE MASON DR SUITE 2D
ARLINGTON VA
22205-3610
US

IV. Provider business mailing address

1701 N GEORGE MASON DR SUITE 2D
ARLINGTON VA
22205-3610
US

V. Phone/Fax

Practice location:
  • Phone: 703-558-5000
  • Fax: 517-787-1027
Mailing address:
  • Phone: 703-558-5000
  • Fax: 517-787-1027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024174485
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: