Individual
MARY BONVISSUTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
11484 WASHINGTON PLZ W STE 300, RESTON, VA 20190-4342
(703) 443-2000
Mailing address
2805 9TH ST S APT 61A, ARLINGTON, VA 22204-2335
(301) 802-2450
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
0024188379
VA
Other
Enumeration date
11/30/2023
Last updated
11/30/2023
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