Basic Information
| Provider Information | |||||||||
| NPI: | 1770931099 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NEIGH | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MS AGACNP-BC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BAEZ | ||||||||
| OtherFirstName: | EMILY | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | MS AGACNP-BC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2000 N BEAUREGARD ST | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039249004 | ||||||||
| FaxNumber: | 7039249067 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 N BEAUREGARD ST | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 223111748 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039249004 | ||||||||
| FaxNumber: | 7039249067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2016 | ||||||||
| LastUpdateDate: | 11/28/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 0001192950 | VA | N | Nursing Service Providers | Registered Nurse | 363LA2100X | 0024174292 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 163W00000X | RN1018223 | DC | N | Nursing Service Providers | Registered Nurse |
ID Information
| ID | Type | State | Issuer | Description | 0024174292 | 01 | VA | VIRGINIA BOARD OF NURSING LICENSED NURSE PRACTITIONER | OTHER |