Basic Information
| Provider Information | |||||||||
| NPI: | 1295233427 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIEFENBACH | ||||||||
| FirstName: | VERONICA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3365 | ||||||||
| Address2: | |||||||||
| City: | MERRIFIELD | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221163365 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1701 N GEORGE MASON DR STE 2D | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 222053610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7035585000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2018 | ||||||||
| LastUpdateDate: | 05/06/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 0001233163 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.