Provider Information for 1043768682
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ANGELA ANN FASANELLA FNP-BC
Sex: Female
NPI: 1043768682
Last Updated: 2024-09-19
Certification Date: 2024-09-19
Certification Date: 2024-09-19
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1043768682 | ||||||||
| Enumeration Date | 2016-09-12 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 17739 MAIN ST STE 110 DUMFRIES, VA 22026-3256 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 17739 MAIN ST STE 110 DUMFRIES, VA 22026-3256 United States Phone: 703-574-3415 | Fax:757-452-5768 | ||||||||
| Secondary Practice Address(es) | 14904 JEFFERSON DAVIS HWY STE 208 9009 SILVERBROOK RD | ||||||||
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