Basic Information
| Provider Information | |||||||||
| NPI: | 1629164389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DUGGAN | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12011 LEE JACKSON MEMORIAL HWY | ||||||||
| Address2: | 504 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220333335 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033912030 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3650 JOSEPH SIEWICK DR | ||||||||
| Address2: | 400 | ||||||||
| City: | FAIRFAX | ||||||||
| State: | VA | ||||||||
| PostalCode: | 220331710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7033912020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 03/23/2015 | ||||||||
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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 | 363LA2100X | 0024140553 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.