Provider Demographics
NPI:1881755163
Name:WIATER, BARBARA RITA (CRNP)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:RITA
Last Name:WIATER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1500 N BEAUREGARD ST STE 200
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22311-1700
Mailing Address - Country:US
Mailing Address - Phone:703-436-1215
Mailing Address - Fax:703-575-9525
Practice Address - Street 1:9010 LORTON STATION BLVD STE 100
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-4796
Practice Address - Country:US
Practice Address - Phone:703-436-1200
Practice Address - Fax:571-642-0392
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024109889363L00000X
VA0001109889363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q00755Medicare UPIN
002889K32Medicare ID - Type Unspecified