Healthcare Provider Details

I. General information

NPI: 1942916267
Provider Name (Legal Business Name): ALLYSON MANUYAG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 02/17/2026
Certification Date: 02/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 TOWN CENTER PKWY
RESTON VA
20190-3298
US

IV. Provider business mailing address

900 N STUART ST APT 509
ARLINGTON VA
22203-4104
US

V. Phone/Fax

Practice location:
  • Phone: 703-471-0919
  • Fax:
Mailing address:
  • Phone: 630-957-8936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024196370
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: