Healthcare Provider Details

I. General information

NPI: 1255367199
Provider Name (Legal Business Name): STEPHANIE J NAVAS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 03/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3990 FETTLER PARK DR
DUMFRIES VA
22025-1997
US

IV. Provider business mailing address

3990 FETTLER PARK DR
DUMFRIES VA
22025-1997
US

V. Phone/Fax

Practice location:
  • Phone: 703-445-8312
  • Fax:
Mailing address:
  • Phone: 703-445-8312
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110003202
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10000297
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: