Healthcare Provider Details

I. General information

NPI: 1184009375
Provider Name (Legal Business Name): LIA MARIA ANDERSON APRN-BC, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2015
Last Update Date: 07/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 DEWITT LOOP FORT BELVOIR COMMUNITY HOSPITAL
FORT BELVOIR VA
22060-5285
US

IV. Provider business mailing address

9300 DEWITT LOOP OL.227L FORT BELVOIR COMMUNITY HOSPITAL
FORT BELVOIR VA
22060
US

V. Phone/Fax

Practice location:
  • Phone: 571-231-4046
  • Fax:
Mailing address:
  • Phone: 571-231-4046
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number209.006939
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License Number0015000869
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: