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General NPI Number Information
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NPI Number | 1205174331
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Entity Type | Individual
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Provider Name | KAALYN ROSE ZIZUS PA-C
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Gender | Female
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Dates
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Enumeration Date | 01/24/2013
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Last Update Date | 10/31/2023
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Provider Practice Location Address
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Address Line | 46175 WESTLAKE DRIVE, SUITE 120
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City | POTOMAC FALLS
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State | VA
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Zip | 20165-5873
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Country | US
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Telephone | 703-444-0100
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Fax | 703-444-7600
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Provider Business Mailing Address
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Address Line | 224-D CORNWALL STREET, NW, SUITE 403
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City | LEESBURG
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State | VA
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Zip | 20176-2704
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Country | US
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Telephone | 703-737-6010
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Fax | 703-443-8643
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110004109
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License Number State | VA
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