MEDICARE: DANIELLE VUKADINOVICH FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024172574	VA

General Provider Information

NPI Number	:	1073991683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELLE VUKADINOVICH FNP-C

Provider Business Mailing Address
First Line	:	1200 N HARTFORD ST
Second Line	:	UNIT 210
City	:	ARLINGTON
State	:	VA
Zip	:	22201-7016
Country	:	US
Telephone Number	:	571-212-4142
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 BELLE VIEW BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6531
Country	:	US
Telephone Number	:	703-768-7044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2015
Last Update Date	:	05/14/2015

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