Miss Loren Anne Ray Tyson, NURSE PRACTITIONER | |
3600 Joseph Siewick Dr, Fairfax, VA 22033-1709 | |
(703) 391-3600 | |
Not Available |
Full Name | Miss Loren Anne Ray Tyson |
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Gender | Female |
Speciality | Nurse Practitioner - Adult Health |
Location | 3600 Joseph Siewick Dr, Fairfax, Virginia |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1295724276 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LA2200X | Nurse Practitioner - Adult Health | 26NJ00060800 (New Jersey) | Secondary |
363LA2200X | Nurse Practitioner - Adult Health | 0024170891 (Virginia) | Primary |
Entity Name | Inova Health Care Services |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1952320061 PECOS PAC ID: 2466351093 Enrollment ID: O20080806000696 |
Entity Name | Signify Health Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1689158487 PECOS PAC ID: 3274895263 Enrollment ID: O20210226002383 |
Mailing Address | Practice Location Address |
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Miss Loren Anne Ray Tyson, NURSE PRACTITIONER 10527 Reeds Landing Cir, Burke, VA 22015-2513 Ph: (201) 232-5162 | Miss Loren Anne Ray Tyson, NURSE PRACTITIONER 3600 Joseph Siewick Dr, Fairfax, VA 22033-1709 Ph: (703) 391-3600 |
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