Provider Demographics
NPI:1376370544
Name:FRANCES, MYLENE
Entity type:Individual
Prefix:
First Name:MYLENE
Middle Name:
Last Name:FRANCES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 N WASHINGTON ST FL 2
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-2543
Mailing Address - Country:US
Mailing Address - Phone:703-639-8830
Mailing Address - Fax:
Practice Address - Street 1:208 N WASHINGTON ST FL 2
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-2543
Practice Address - Country:US
Practice Address - Phone:703-639-8830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAFMF2060161261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center