Provider Demographics
NPI:1467275842
Name:BASTAWROUS, MEGAN (FNP-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:BASTAWROUS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2840 HUNTER RD
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-1418
Mailing Address - Country:US
Mailing Address - Phone:571-283-9758
Mailing Address - Fax:
Practice Address - Street 1:3028 JAVIER RD STE 300
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4622
Practice Address - Country:US
Practice Address - Phone:703-698-8960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-05
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024191581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily