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NPI Code Detail

MEDICARE: MARIA LUCILLE FAIN CRNA

MEDICARE: MARIA LUCILLE FAIN CRNA
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
1367500000XCertified Registered Nurse Anesthetist0021467208VA
2367500000XCertified Registered Nurse AnesthetistRN67020DC

General Provider Information

NPI Number : 1407854250
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIA LUCILLE FAIN CRNA
Provider Business Mailing Address
First Line : 11781 LEE JACKSON MEMORIAL HWY
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-3309
Country : US
Telephone Number : 571-777-5164
Fax Number :
Provider Business Practice Location Address
First Line : 3600 JOSEPH SIEWICK DR
Second Line :
City : FAIRFAX
State : VA
Zip : 22033-1709
Country : US
Telephone Number : 703-391-3129
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2005
Last Update Date : 07/01/2019

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Directions to “ MARIA LUCILLE FAIN CRNA” Practice Location

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