Healthcare Provider Details

I. General information

NPI: 1235731183
Provider Name (Legal Business Name): CHRISTINE EMBER LIENAU PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2020
Last Update Date: 11/14/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 GREENSBORO DR STE 801
MC LEAN VA
22102-4925
US

IV. Provider business mailing address

8200 GREENSBORO DR STE 801
MC LEAN VA
22102-4925
US

V. Phone/Fax

Practice location:
  • Phone: 703-942-9787
  • Fax: 703-563-3824
Mailing address:
  • Phone: 703-717-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number0110007551
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: