MEDICARE: LINDSAY SHMATOV 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
1	363L00000X	Nurse Practitioner	0024171323	VA

General Provider Information

NPI Number	:	1801226121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSAY SHMATOV FNP

Provider Business Mailing Address
First Line	:	6355 WALKER LN STE 311
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3258
Country	:	US
Telephone Number	:	703-822-0222
Fax Number	:

Provider Business Practice Location Address
First Line	:	6355 WALKER LN STE 311
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22310-3258
Country	:	US
Telephone Number	:	703-822-0222
Fax Number	:

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

Provider Enumeration Date	:	11/22/2013
Last Update Date	:	06/19/2014

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