1447245733 NPI number — EVA C ABRENICA CRNA

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447245733 NPI number — EVA C ABRENICA CRNA

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ABRENICA

Provider First Name:

EVA

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

CRNA

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1447245733

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/03/2015

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

3998 FAIR RIDGE DRIVE

Provider Second Line Business Mailing Address:

SUITE 300

Provider Business Mailing Address City Name:

FAIRFAX

Provider Business Mailing Address State Name:

VA

Provider Business Mailing Address Postal Code:

22033-2921

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

703-295-9360

Provider Business Mailing Address Fax Number:

703-766-9725

Provider First Line Business Practice Location Address:

3600 JOSEPH SIEWICK DRIVE

Provider Second Line Business Practice Location Address:

FAIR OAKS HOSPITAL

Provider Business Practice Location Address City Name:

FAIRFAX

Provider Business Practice Location Address State Name:

VA

Provider Business Practice Location Address Postal Code:

22033

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

703-295-9360

Provider Business Practice Location Address Fax Number:

703-295-9369

Provider Enumeration Date:

09/13/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 367500000X , with the licence number:  8789 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 367500000X , with the licence number: 0024166978 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 261966 . This is a "ANTHEM BCBS" identifier . This identifiers is of the category "OTHER".
• Identifier: 010296307 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: P00377928 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: 1447245733 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 430025004 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 010296323 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
• Identifier: 139180 . This is a "ANTHEM" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
• Identifier: K142-0002 . This is a "CAREFIRST" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
• Identifier: 00013859 . This is a "NHC CARE ADMINISTRATORS" identifier . This identifiers is of the category "OTHER".
• Identifier: 010295807 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".