Individual
MACKENZIE BOX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1830 TOWN CENTER DR STE 205, RESTON, VA 20190-3236
(703) 435-3636
Mailing address
4060 GATEWAY DR APT 5233, FAIRFAX, VA 22030-5077
(731) 267-9424
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001317538
VA
363LP0200X
Pediatric Nurse Practitioner
Primary
0024186498
VA
Other
Enumeration date
02/01/2023
Last updated
10/20/2023
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