Provider Demographics
NPI:1841209707
Name:BAER, DEBRA M (NP)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:M
Last Name:BAER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14675 LEE RD
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1708
Mailing Address - Country:US
Mailing Address - Phone:703-808-7425
Mailing Address - Fax:
Practice Address - Street 1:14675 LEE RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1708
Practice Address - Country:US
Practice Address - Phone:703-808-7425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166562363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1841209707Medicaid
VAVVH745AMedicare PIN
VAP63379Medicare UPIN
DC419230ZC3UMedicare PIN