Provider Demographics
NPI:1407503949
Name:NEMIROVSKY, NATALI EDITH
Entity Type:Individual
Prefix:
First Name:NATALI
Middle Name:EDITH
Last Name:NEMIROVSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8174 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20111-2822
Mailing Address - Country:US
Mailing Address - Phone:703-587-7563
Mailing Address - Fax:
Practice Address - Street 1:1850 TOWN CENTER PKWY
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3204
Practice Address - Country:US
Practice Address - Phone:703-689-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-04
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001269989163W00000X
VA0024186289367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse