Provider Demographics
NPI:1700112596
Name:BEN AIDA, ANISSA M (NP)
Entity Type:Individual
Prefix:
First Name:ANISSA
Middle Name:M
Last Name:BEN AIDA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:370 MAPLE AVE W
Mailing Address - Street 2:SUITE V
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22180-5615
Mailing Address - Country:US
Mailing Address - Phone:703-938-4604
Mailing Address - Fax:703-938-4618
Practice Address - Street 1:370 MAPLE AVE W
Practice Address - Street 2:SUITE V
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22180-5615
Practice Address - Country:US
Practice Address - Phone:703-938-4604
Practice Address - Fax:703-938-4618
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024168447363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily