Provider Demographics
NPI:1710162029
Name:MIKULAK, LENA MARGARETA (FNP)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:MARGARETA
Last Name:MIKULAK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 LAFAYETTE CENTER DR
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1261
Mailing Address - Country:US
Mailing Address - Phone:703-352-3344
Mailing Address - Fax:703-796-1918
Practice Address - Street 1:4229 LAFAYETTE CENTER DR
Practice Address - Street 2:SUITE 1000
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1261
Practice Address - Country:US
Practice Address - Phone:703-352-3344
Practice Address - Fax:703-796-1918
Is Sole Proprietor?:No
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024167634363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily