Provider Demographics
NPI:1528637618
Name:BAROSY, MYRGINE (NP)
Entity type:Individual
Prefix:
First Name:MYRGINE
Middle Name:
Last Name:BAROSY
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 1:5372 FALLOWATER LN
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-0907
Mailing Address - Country:US
Mailing Address - Phone:703-798-5295
Mailing Address - Fax:
Practice Address - Street 1:623 JEFFERSON DAVIS HWY STE 101
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401-4437
Practice Address - Country:US
Practice Address - Phone:703-798-5295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-22
Last Update Date:2021-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181573363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health