Healthcare Provider Details

I. General information

NPI: 1548683733
Provider Name (Legal Business Name): JANNEN LEE PALLAS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JANNEN LEE MEYER

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JOSEPH SIEWICK DR
FAIRFAX VA
22033-1709
US

IV. Provider business mailing address

68 S SERVICE RD STE 350
MELVILLE NY
11747-2358
US

V. Phone/Fax

Practice location:
  • Phone: 703-293-9590
  • Fax:
Mailing address:
  • Phone: 516-945-3107
  • Fax: 516-945-3131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024171455
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001203329
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: