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General NPI Number Information
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NPI Number | 1770449035
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Entity Type | Individual
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Provider Name | MARISSA RAJA WIEGAND NP
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Gender | Female
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 43777 CENTRAL STATION DR STE 360
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City | ASHBURN
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State | VA
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Zip | 20147-5961
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Country | US
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Telephone | 703-763-0116
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Fax |
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Provider Business Mailing Address
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Address Line | 2300 TODDSBURY PL
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City | RESTON
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State | VA
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Zip | 20191-1623
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Country | US
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Telephone | 703-401-6126
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024194632
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License Number State | VA
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