Provider Demographics
NPI:1235731183
Name:LIENAU, CHRISTINE EMBER (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:EMBER
Last Name:LIENAU
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8200 GREENSBORO DR STE 801
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-4925
Mailing Address - Country:US
Mailing Address - Phone:703-717-3180
Mailing Address - Fax:
Practice Address - Street 1:8200 GREENSBORO DR STE 801
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-4925
Practice Address - Country:US
Practice Address - Phone:703-942-9787
Practice Address - Fax:703-563-3824
Is Sole Proprietor?:No
Enumeration Date:2020-11-14
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110007551363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical