Provider Demographics
NPI:1407622533
Name:MUCKELVENE, LAUREN (FNP-C)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:MUCKELVENE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 ARMY NAVY DR APT 1419
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-4932
Mailing Address - Country:US
Mailing Address - Phone:703-447-7102
Mailing Address - Fax:
Practice Address - Street 1:2200 OPITZ BLVD STE 320
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3349
Practice Address - Country:US
Practice Address - Phone:703-770-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-29
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188844363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty