Provider Demographics
NPI:1487923397
Name:MARADIEGUE, ANN H (NP)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:H
Last Name:MARADIEGUE
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 1:6196 ARLINGTON BLVD
Mailing Address - Street 2:BAILEY'S HEALTH CENTER
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22044
Mailing Address - Country:US
Mailing Address - Phone:703-237-3448
Mailing Address - Fax:
Practice Address - Street 1:6150 BEACHWAY DR
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22041-1429
Practice Address - Country:US
Practice Address - Phone:703-820-1426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024060584363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner