Basic Information
Provider Information
NPI: 1528783412
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SOLLOWAY
FirstName: ALYSON
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: ACNPC-AG
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4932 34TH ST N
Address2:  
City: ARLINGTON
State: VA
PostalCode: 222072806
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 1701 N GEORGE MASON DR
Address2:  
City: ARLINGTON
State: VA
PostalCode: 222053610
CountryCode: US
TelephoneNumber: 7035585000
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/04/2022
LastUpdateDate: 10/20/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/20/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LA2100X0001315361VAY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care

No ID Information.


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