Provider Demographics
NPI:1750573242
Name:AMINRAZAVI, MARYLYNN (NP)
Entity type:Individual
Prefix:MRS
First Name:MARYLYNN
Middle Name:
Last Name:AMINRAZAVI
Suffix:
Gender:F
Credentials:NP
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Other - Last Name:
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Mailing Address - Street 1:2150 PENNSYLVANIA AVE NW
Mailing Address - Street 2:SUITE 3-438
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-3201
Mailing Address - Country:US
Mailing Address - Phone:202-741-2283
Mailing Address - Fax:202-741-2285
Practice Address - Street 1:2150 PENNSYLVANIA AVE NW
Practice Address - Street 2:SUITE 3-438
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-3201
Practice Address - Country:US
Practice Address - Phone:202-741-2283
Practice Address - Fax:202-741-2285
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024167494363LF0000X
DCRN1025151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily