Provider Demographics
NPI:1407370034
Name:DARE, REIDUN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:REIDUN
Middle Name:
Last Name:DARE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9516 FALLS BRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-3954
Mailing Address - Country:US
Mailing Address - Phone:301-302-2780
Mailing Address - Fax:
Practice Address - Street 1:1469 28TH ST S APT 8
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22206-3726
Practice Address - Country:US
Practice Address - Phone:301-302-2780
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-26
Last Update Date:2020-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily