Individual
MARYAM N/A NICKSOLAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8370 GREENSBORO DR, MC LEAN, VA 22102-3515
(703) 200-7727
Mailing address
8370 GREENSBORO DR, MC LEAN, VA 22102-3515
(703) 200-7727
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110001340
VA
Other
Enumeration date
10/16/2006
Last updated
04/24/2017
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