Provider Demographics
NPI:1821420225
Name:CORRALES, MICHAELENA MEGAN ALEXANDRIA (RN)
Entity type:Individual
Prefix:MRS
First Name:MICHAELENA
Middle Name:MEGAN ALEXANDRIA
Last Name:CORRALES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11920 SUGARLAND RD
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2307
Mailing Address - Country:US
Mailing Address - Phone:703-398-2666
Mailing Address - Fax:
Practice Address - Street 1:11920 SUGARLAND RD
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-2307
Practice Address - Country:US
Practice Address - Phone:703-398-2666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001242748163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse