Provider Demographics
NPI:1194355388
Name:VALCOURT, MARYANN (CPNP-BC)
Entity type:Individual
Prefix:
First Name:MARYANN
Middle Name:
Last Name:VALCOURT
Suffix:
Gender:F
Credentials:CPNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8988 FERN PARK DR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-1635
Mailing Address - Country:US
Mailing Address - Phone:703-978-6061
Mailing Address - Fax:
Practice Address - Street 1:8988 FERN PARK DR
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-1635
Practice Address - Country:US
Practice Address - Phone:703-978-6061
Practice Address - Fax:703-978-0291
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-16
Last Update Date:2020-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024164946363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics