MEDICARE: MRS. ANNE LOUISE PINGREY APRN BC

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	363LA2200X	Adult Health Nurse Practitioner	0017138358	VA

General Provider Information

NPI Number	:	1467675959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNE LOUISE PINGREY APRN BC

Provider Business Mailing Address
First Line	:	PO BOX 3910
Second Line	:
City	:	FREDERICKSBURG
State	:	VA
Zip	:	22402-3910
Country	:	US
Telephone Number	:	540-785-9900
Fax Number	:	540-785-9960

Provider Business Practice Location Address
First Line	:	1075 GARRISONVILLE RD
Second Line	:	SUITE 115
City	:	STAFFORD
State	:	VA
Zip	:	22556-8600
Country	:	US
Telephone Number	:	540-785-9900
Fax Number	:	540-785-9960

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

Provider Enumeration Date	:	04/11/2007
Last Update Date	:	09/04/2008

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