Healthcare Provider Details

I. General information

NPI: 1942719489
Provider Name (Legal Business Name): MELISA JANE NEMEC PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISA JANE WATSON

II. Dates (important events)

Enumeration Date: 09/27/2017
Last Update Date: 03/22/2024
Certification Date: 03/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 SUDLEY RD
MANASSAS VA
20110-4418
US

IV. Provider business mailing address

1095 GREAT OAK RD
FOREST VA
24551-2368
US

V. Phone/Fax

Practice location:
  • Phone: 703-396-5292
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110005921
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: