Provider Demographics
NPI:1619731841
Name:MERCER, DIANA K
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:K
Last Name:MERCER
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 1:464 HERNDON PKWY STE 116
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-5200
Mailing Address - Country:US
Mailing Address - Phone:703-981-9393
Mailing Address - Fax:
Practice Address - Street 1:464 HERNDON PKWY STE 116
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-5200
Practice Address - Country:US
Practice Address - Phone:703-981-9393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0019011818163WM1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM1400XNursing Service ProvidersRegistered NurseNurse Massage Therapist (NMT)