Provider Demographics
NPI:1063714244
Name:MCGOVERN, CRYSTAL ANN (NP)
Entity type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:ANN
Last Name:MCGOVERN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8640 SUDLEY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4404
Mailing Address - Country:US
Mailing Address - Phone:703-368-6819
Mailing Address - Fax:703-330-2923
Practice Address - Street 1:8640 SUDLEY RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4420
Practice Address - Country:US
Practice Address - Phone:703-368-6819
Practice Address - Fax:703-330-2923
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-22
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024168953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily