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General NPI Number Information
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NPI Number | 1295724276
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Entity Type | Individual
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Provider Name | LOREN ANNE RAY TYSON NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 09/30/2022
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Provider Practice Location Address
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Address Line | 3600 JOSEPH SIEWICK DR
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City | FAIRFAX
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State | VA
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Zip | 22033-1709
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Country | US
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Telephone | 703-391-3600
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Fax |
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Provider Business Mailing Address
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Address Line | 10527 REEDS LANDING CIR
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City | BURKE
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State | VA
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Zip | 22015-2513
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Country | US
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Telephone | 201-232-5162
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Fax | 703-289-4612
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 26NJ00060800
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024170891
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License Number State | VA
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