Healthcare Provider Details

I. General information

NPI: 1790041747
Provider Name (Legal Business Name): MARGARITA WYCKO N.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2012
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

9300 DEWITT LOOP OAKS, 5TH FLOOR, ROOM O5.343C
FORT BELVOIR VA
22060-5285
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-4789
  • Fax:
Mailing address:
  • Phone: 571-231-4729
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number0024169315
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: