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NPI Code Detail

MEDICARE: MISS LOREN ANNE RAY TYSON NURSE PRACTITIONER

MEDICARE: MISS LOREN ANNE RAY TYSON NURSE PRACTITIONER
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
1363LA2200XAdult Health Nurse Practitioner26NJ00060800NJ
2363LA2200XAdult Health Nurse Practitioner0024170891VA

General Provider Information

NPI Number : 1295724276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS LOREN ANNE RAY TYSON NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 10527 REEDS LANDING CIR
Second Line :
City : BURKE
State : VA
Zip : 22015-2513
Country : US
Telephone Number : 201-232-5162
Fax Number : 703-289-4612
Provider Business Practice Location Address
First Line : 3600 JOSEPH SIEWICK DR
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-1709
Country : US
Telephone Number : 703-391-3600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2005
Last Update Date : 09/30/2022

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Directions to “ MISS LOREN ANNE RAY TYSON NURSE PRACTITIONER” Practice Location

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