Provider Demographics
NPI:1699000307
Name:PEREZ, STEPHEN M (ANP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:M
Credentials:ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8001 FORBES PL
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22151-2208
Mailing Address - Country:US
Mailing Address - Phone:703-321-2600
Mailing Address - Fax:703-321-2603
Practice Address - Street 1:8001 FORBES PL
Practice Address - Street 2:SUITE 200
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22151-2208
Practice Address - Country:US
Practice Address - Phone:703-321-2600
Practice Address - Fax:703-321-2603
Is Sole Proprietor?:No
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017139518363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1760571889Medicaid
VA1336115781Medicaid
VA1497993752Medicaid