Provider Demographics
NPI:1073578811
Name:GYURJYAN, ANNA (NP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:GYURJYAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-594-3636
Mailing Address - Fax:757-594-4310
Practice Address - Street 1:500 J. CLYDE MORRIS BLVD
Practice Address - Street 2:BLD G
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601
Practice Address - Country:US
Practice Address - Phone:757-594-3636
Practice Address - Fax:757-594-4310
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165126363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC03878OtherBC/BS NC
NC7003878Medicaid
VAPAROtherCORVEL/CORCARE
VAPAROtherUSA MANAGED CARE
VAPAROtherMULTIPLAN
VA-010OtherTRICARE/CHAMPUS
VAPAROtherVIRGINIA PREMIER HEALTH
VA010354153Medicaid
VA10012548NOtherSHP/OHP
VA-010OtherTRICARE/CHAMPUS
NC03878OtherBC/BS NC