Healthcare Provider Details

I. General information

NPI: 1699000307
Provider Name (Legal Business Name): STEPHEN M PEREZ ANP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 10/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8001 FORBES PL SUITE 200
SPRINGFIELD VA
22151-2208
US

IV. Provider business mailing address

8001 FORBES PL SUITE 200
SPRINGFIELD VA
22151-2208
US

V. Phone/Fax

Practice location:
  • Phone: 703-321-2600
  • Fax: 703-321-2603
Mailing address:
  • Phone: 703-321-2600
  • Fax: 703-321-2603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0017139518
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: