Provider Demographics
NPI:1033583489
Name:LANZETTA, KALEY (CRNA)
Entity Type:Individual
Prefix:
First Name:KALEY
Middle Name:
Last Name:LANZETTA
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:11781 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 550
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3309
Mailing Address - Country:US
Mailing Address - Phone:571-777-5100
Mailing Address - Fax:703-295-9369
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-391-3129
Practice Address - Fax:703-391-3006
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-23
Last Update Date:2016-01-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0024173199367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered