Healthcare Provider Details

I. General information

NPI: 1063427763
Provider Name (Legal Business Name): ANNETTE DOROTHY BLAKESLEE ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9900 VIENNA PL
DULLES VA
20189-9900
US

IV. Provider business mailing address

9900 VIENNA PL
DULLES VA
20189-9900
US

V. Phone/Fax

Practice location:
  • Phone: 431-320-0367
  • Fax: 131-339-2915
Mailing address:
  • Phone: 431-320-0367
  • Fax: 131-339-2915

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number502428
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: