Healthcare Provider Details

I. General information

NPI: 1588724017
Provider Name (Legal Business Name): MARJORIE GRAZIANO CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14139 POTOMAC MILLS ROAD
WOODBRIDGE VA
22192-4644
US

IV. Provider business mailing address

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNIT 6 W KAISER PERMANENTE MIDATLANTIC PERMANENTE MEDICAL GRP PC
ROCKVILLE MD
20852-4908
US

V. Phone/Fax

Practice location:
  • Phone: 703-490-8400
  • Fax: 703-490-7635
Mailing address:
  • Phone: 301-816-6660
  • Fax: 301-816-6308

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024162362
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0001162362
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: