Provider Demographics
NPI:1255753513
Name:PHILIP-CYPRIEN, WENDYALINE (CRNA)
Entity type:Individual
Prefix:
First Name:WENDYALINE
Middle Name:
Last Name:PHILIP-CYPRIEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6246 WALKERS CROFT WAY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5227
Mailing Address - Country:US
Mailing Address - Phone:904-891-4052
Mailing Address - Fax:
Practice Address - Street 1:15195 HEATHCOTE BLVD STE 210
Practice Address - Street 2:
Practice Address - City:HAYMARKET
Practice Address - State:VA
Practice Address - Zip Code:20169-6245
Practice Address - Country:US
Practice Address - Phone:571-445-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-06
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR165093163W00000X, 363L00000X
VA0024182368363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse