Provider Demographics
NPI:1699820753
Name:PEW, CAROL EVANS (LNP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:EVANS
Last Name:PEW
Suffix:
Gender:F
Credentials:LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8501 ARLINGTON BLVD
Mailing Address - Street 2:340
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4617
Mailing Address - Country:US
Mailing Address - Phone:703-207-0733
Mailing Address - Fax:703-207-0736
Practice Address - Street 1:8501 ARLINGTON BLVD
Practice Address - Street 2:340
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4617
Practice Address - Country:US
Practice Address - Phone:703-207-0733
Practice Address - Fax:703-207-0736
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024166350363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner