Healthcare Provider Details

I. General information

NPI: 1134331853
Provider Name (Legal Business Name): MARY N YEANEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6565 ARLINGTON BLVD. STE 200
FALLS CHURCH VA
22042
US

IV. Provider business mailing address

6565 ARLINGTON BLVD. STE 200
FALLS CHURCH VA
22042
US

V. Phone/Fax

Practice location:
  • Phone: 703-531-3627
  • Fax: 703-531-1591
Mailing address:
  • Phone: 703-531-3627
  • Fax: 703-531-1591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN57476
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: