Provider Demographics
NPI:1962019505
Name:CHOW, DIANE LANE (NP)
Entity Type:Individual
Prefix:MS
First Name:DIANE
Middle Name:LANE
Last Name:CHOW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1447 WOODHURST BLVD
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-2234
Mailing Address - Country:US
Mailing Address - Phone:703-582-4104
Mailing Address - Fax:703-707-0949
Practice Address - Street 1:1860 TOWN CENTER DR STE 255
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5906
Practice Address - Country:US
Practice Address - Phone:703-707-0607
Practice Address - Fax:703-707-0949
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180137363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily