Provider Demographics
NPI:1336712595
Name:ALVARADO, MICHELLE MARILYN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:MARILYN
Last Name:ALVARADO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14461 SNAKE CASTLE RD
Mailing Address - Street 2:
Mailing Address - City:SUMERDUCK
Mailing Address - State:VA
Mailing Address - Zip Code:22742-2037
Mailing Address - Country:US
Mailing Address - Phone:571-643-2448
Mailing Address - Fax:
Practice Address - Street 1:8100 ASHTON AVE STE 101
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20109-5647
Practice Address - Country:US
Practice Address - Phone:703-257-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-23
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2021031910363L00000X
VA0024182306363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner