Provider Demographics
NPI:1417036351
Name:MORRISSETTE, ROBYN MICHELLE (PA-C, ATC-R)
Entity Type:Individual
Prefix:MRS
First Name:ROBYN
Middle Name:MICHELLE
Last Name:MORRISSETTE
Suffix:
Gender:F
Credentials:PA-C, ATC-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6206 SANDLIN CT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-3146
Mailing Address - Country:US
Mailing Address - Phone:703-727-6473
Mailing Address - Fax:
Practice Address - Street 1:3023 HAMAKER CT
Practice Address - Street 2:SUITE 300
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-2207
Practice Address - Country:US
Practice Address - Phone:571-405-5715
Practice Address - Fax:571-405-5916
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPA030462363A00000X
VA0110002417363AS0400X
MDC03941363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant