Individual
MISS LUCRISHA M BANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
3700 JOSEPH SIEWICK DR, SUITE 403, FAIRFAX, VA 22033-1744
(703) 648-2488
(703) 648-2489
Mailing address
3700 JOSEPH SIEWICK DR, SUITE 403, FAIRFAX, VA 22033-1744
(703) 648-2488
(703) 648-2489
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002011
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1497888697
NPI
VA
Enumeration date
03/14/2007
Last updated
05/20/2011
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