Healthcare Provider Details

I. General information

NPI: 1417036351
Provider Name (Legal Business Name): ROBYN MICHELLE MORRISSETTE PA-C, ATC-R
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 04/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3023 HAMAKER CT SUITE 300
FAIRFAX VA
22031-2207
US

IV. Provider business mailing address

6206 SANDLIN CT
ALEXANDRIA VA
22310-3146
US

V. Phone/Fax

Practice location:
  • Phone: 571-405-5715
  • Fax: 571-405-5916
Mailing address:
  • Phone: 703-727-6473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA030462
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number0110002417
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberC03941
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: