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General NPI Number Information
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NPI Number | 1760104178
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Entity Type | Individual
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Provider Name | MICHELLE WAVERLY EVANS MSN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/13/2022
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Last Update Date | 09/13/2022
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Provider Practice Location Address
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Address Line | 301 MAPLE AVE W STE 120
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City | VIENNA
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State | VA
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Zip | 22180-4303
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Country | US
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Telephone | 703-938-8885
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Fax | 703-242-2437
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Provider Business Mailing Address
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Address Line | 9373 PETER ROY CT
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City | BURKE
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State | VA
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Zip | 22015-4265
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Country | US
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Telephone | 757-319-1228
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 0024185187
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License Number State | VA
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