Basic Information
| Provider Information | |||||||||
| NPI: | 1952617169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HENZEY | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | ALANE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13525 DULLES TECHNOLOGY DR | ||||||||
| Address2: | PO BOX 5143 | ||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201713413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034818160 | ||||||||
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| Practice Location | |||||||||
| Address1: | 13525 DULLES TECHNOLOGY DR | ||||||||
| Address2: | |||||||||
| City: | HERNDON | ||||||||
| State: | VA | ||||||||
| PostalCode: | 201713413 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7034818160 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/25/2010 | ||||||||
| LastUpdateDate: | 08/25/2010 | ||||||||
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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 | 363LF0000X | 0024168933 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.