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NPI Code Detail

MEDICARE: MICHELLE EVANSON FNP

MEDICARE:   MICHELLE  EVANSON  FNP
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
1363LF0000XFamily Nurse Practitioner0024165739VA

General Provider Information

NPI Number : 1396723946
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE EVANSON FNP
Provider Business Mailing Address
First Line : 3804 EXECUTIVE AVE
Second Line : APT D-1
City : ALEXANDRIA
State : VA
Zip : 22305-2118
Country : US
Telephone Number : 703-519-1725
Fax Number : 703-519-1738
Provider Business Practice Location Address
First Line : 3804 EXECUTIVE AVE
Second Line : APT D-1
City : ALEXANDRIA
State : VA
Zip : 22305-2118
Country : US
Telephone Number : 703-519-1725
Fax Number : 703-519-1738
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2006
Last Update Date : 04/18/2014

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Directions to “ MICHELLE EVANSON FNP” Practice Location

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