Provider Demographics
NPI:1669790440
Name:FAKHRIYAZDI, MEHRNOUSH RAFATI (APRN-C)
Entity type:Individual
Prefix:MRS
First Name:MEHRNOUSH
Middle Name:RAFATI
Last Name:FAKHRIYAZDI
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3132
Mailing Address - Country:US
Mailing Address - Phone:703-425-8618
Mailing Address - Fax:703-425-8743
Practice Address - Street 1:9520 BURKE RD
Practice Address - Street 2:
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3132
Practice Address - Country:US
Practice Address - Phone:703-425-8616
Practice Address - Fax:703-425-8743
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-04
Last Update Date:2010-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001124820163W00000X
VA0024165408363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse