Provider Demographics
NPI:1720099492
Name:RAYMOND, ROSEMARIE ANN (APRN-BC NP)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARIE
Middle Name:ANN
Last Name:RAYMOND
Suffix:
Gender:F
Credentials:APRN-BC NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12001 MARKET ST
Mailing Address - Street 2:226
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-6209
Mailing Address - Country:US
Mailing Address - Phone:571-313-0438
Mailing Address - Fax:703-435-1961
Practice Address - Street 1:12001 MARKET ST
Practice Address - Street 2:226
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-6209
Practice Address - Country:US
Practice Address - Phone:571-313-0438
Practice Address - Fax:703-435-1961
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0710001227101YA0400X
VA0001075685163W00000X
VA0024075685363LP2300X
VA0015000635364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No163W00000XNursing Service ProvidersRegistered Nurse
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4945107Medicaid
VA4945107Medicaid
VA012939M25Medicare ID - Type UnspecifiedPROVIDER NUMBER
VA4945107Medicaid