Provider Demographics
NPI:1295724276
Name:RAY TYSON, LOREN ANNE (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MISS
First Name:LOREN
Middle Name:ANNE
Last Name:RAY TYSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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Mailing Address - Street 1:10527 REEDS LANDING CIR
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-2513
Mailing Address - Country:US
Mailing Address - Phone:201-232-5162
Mailing Address - Fax:703-289-4612
Practice Address - Street 1:3600 JOSEPH SIEWICK DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1709
Practice Address - Country:US
Practice Address - Phone:703-391-3600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NJ26NJ00060800363LA2200X
VA0024170891363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health