Provider Demographics
NPI:1316621253
Name:VASQUEZ, ALISON (FNP-BC)
Entity type:Individual
Prefix:
First Name:ALISON
Middle Name:
Last Name:VASQUEZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1715 N GEORGE MASON DR STE 410
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22205-3666
Mailing Address - Country:US
Mailing Address - Phone:703-524-4792
Mailing Address - Fax:
Practice Address - Street 1:1715 N GEORGE MASON DR STE 410
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-3666
Practice Address - Country:US
Practice Address - Phone:703-524-4792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-12
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001266087163WG0100X
VA0024187511363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WG0100XNursing Service ProvidersRegistered NurseGastroenterology