Provider Demographics
NPI:1154051837
Name:RAJA, PRIYA (ACNPC-AG)
Entity Type:Individual
Prefix:MRS
First Name:PRIYA
Middle Name:
Last Name:RAJA
Suffix:
Gender:F
Credentials:ACNPC-AG
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5701 WOODLAWN GABLE DR APT B
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-4616
Mailing Address - Country:US
Mailing Address - Phone:703-772-0562
Mailing Address - Fax:
Practice Address - Street 1:5701 WOODLAWN GABLE DR APT B
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-4616
Practice Address - Country:US
Practice Address - Phone:703-772-0562
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2000388698363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care