Individual
MS. VICKI J CARLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3600 JOSEPH SIEWICK DR, FAIRFAX, VA 22033-1709
(703) 391-3600
Mailing address
3998 FAIR RIDGE DR, STE 300, FAIRFAX, VA 22033-2921
(703) 766-9737
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024166330
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144315953
—
VA
01
—
139180
ANTHEM
VA
01
—
301907
AMERIGROUP
VA
01
—
484645
NCPPO
VA
01
—
K142-0002
CAREFIRST
DC
01
—
P00313213
RAILROAD MEDICARE
VA
Enumeration date
10/04/2006
Last updated
04/23/2015
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