Individual
MS. DIANA J ORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
422 GARRISONVILLE RD, SUITE 111, STAFFORD, VA 22554-1573
(540) 720-8000
(540) 657-4366
Mailing address
PO BOX 729, GARRISONVILLE, VA 22463-0729
(540) 720-0400
(540) 657-4366
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110002374
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0110002374
VIRGINIA LICENSE
VA
Enumeration date
09/01/2006
Last updated
07/08/2007
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