Healthcare Provider Details

I. General information

NPI: 1720099492
Provider Name (Legal Business Name): ROSEMARIE ANN RAYMOND APRN-BC NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12001 MARKET ST 226
RESTON VA
20190-6209
US

IV. Provider business mailing address

12001 MARKET ST 226
RESTON VA
20190-6209
US

V. Phone/Fax

Practice location:
  • Phone: 571-313-0438
  • Fax: 703-435-1961
Mailing address:
  • Phone: 571-313-0438
  • Fax: 703-435-1961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number0710001227
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001075685
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024075685
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015000635
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: