Provider Demographics
NPI:1225788870
Name:PETERS, ERYN LAJOIE (AGPCNP-BS)
Entity Type:Individual
Prefix:
First Name:ERYN
Middle Name:LAJOIE
Last Name:PETERS
Suffix:
Gender:F
Credentials:AGPCNP-BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3040 WILLIAMS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:571-350-8400
Mailing Address - Fax:703-940-8692
Practice Address - Street 1:7901 LAKE MANASSAS DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:VA
Practice Address - Zip Code:20155-3257
Practice Address - Country:US
Practice Address - Phone:571-350-8400
Practice Address - Fax:571-222-2202
Is Sole Proprietor?:No
Enumeration Date:2022-03-26
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001262735163W00000X
VA0024184818363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1225788870Medicaid