Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 0024175817 | VA |
N | 363LA2100X | Nurse Practitioner - Acute Care | 0024175817 | VA |
NPI | 1033608989 |
---|---|
Provider Name | Liana E Matevosian |
First Address | Baltimore, MD 21297-3174 |
Second Address | Alexandria, VA 22304-1535 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/05/2018 |
Last Update Date | 09/06/2021 |