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General NPI Number Information
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NPI Number | 1174195671
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Entity Type | Individual
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Provider Name | LYNNITA ANDREA MONTAGUE-DADDIO NP-CNS, RN
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Gender | Female
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 07/14/2021
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Provider Practice Location Address
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Address Line | 1701 N GEORGE MASON DR
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City | ARLINGTON
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State | VA
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Zip | 22205-3610
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Country | US
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Telephone | 703-254-4261
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Fax |
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Provider Business Mailing Address
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Address Line | 9775 OLEANDER AVE
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City | VIENNA
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State | VA
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Zip | 22181-6037
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Country | US
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Telephone | 703-254-4261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024181940
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 364S00000X
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Taxonomy Name | Clinical Nurse Specialist
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License Number | 0015000984
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 0001211544
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License Number State | VA
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