Provider Demographics
NPI:1740838978
Name:DE LAS ALAS, NICOLE (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:DE LAS ALAS
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41816 FENWAY CIR
Mailing Address - Street 2:
Mailing Address - City:ASHBURN
Mailing Address - State:VA
Mailing Address - Zip Code:20148-8069
Mailing Address - Country:US
Mailing Address - Phone:347-761-7200
Mailing Address - Fax:
Practice Address - Street 1:41816 FENWAY CIR
Practice Address - Street 2:
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20148-8069
Practice Address - Country:US
Practice Address - Phone:347-761-7200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178155363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily