Provider Demographics
NPI:1316157159
Name:CARREIRO POWE, LUISA I (PA-C)
Entity type:Individual
Prefix:MS
First Name:LUISA
Middle Name:I
Last Name:CARREIRO POWE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9610 CANDISH CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-3235
Mailing Address - Country:US
Mailing Address - Phone:703-493-8994
Mailing Address - Fax:
Practice Address - Street 1:5631 BURKE CENTRE PKWY
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-2234
Practice Address - Country:US
Practice Address - Phone:703-250-5171
Practice Address - Fax:703-250-5170
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110001138363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical