Provider Demographics
NPI:1417493750
Name:PEGO, MICHELLE IRENE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:IRENE
Last Name:PEGO
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 1:952 EDWARDS FERRY RD NE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-3324
Mailing Address - Country:US
Mailing Address - Phone:703-687-4158
Mailing Address - Fax:
Practice Address - Street 1:952 EDWARDS FERRY RD NE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-3324
Practice Address - Country:US
Practice Address - Phone:703-687-4158
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-10
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174355363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily