Provider Demographics
NPI:1790395176
Name:PARAGON MEDPSYCHIATRY SERVFICES
Entity Type:Organization
Organization Name:PARAGON MEDPSYCHIATRY SERVFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:DANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHL
Authorized Official - Suffix:
Authorized Official - Credentials:MSN, FNP-C, PMHNP-BC
Authorized Official - Phone:703-463-8638
Mailing Address - Street 1:9300 FOREST POINT CIR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4765
Mailing Address - Country:US
Mailing Address - Phone:703-493-1483
Mailing Address - Fax:
Practice Address - Street 1:9300 FOREST POINT CIR
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4765
Practice Address - Country:US
Practice Address - Phone:703-493-1483
Practice Address - Fax:470-201-6414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-31
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty