Individual
STACIA A MAHONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGPC NP-C
Contact information
Practice address
8081 INNOVATION PARK DR STE 900, FAIRFAX, VA 22031-4867
(571) 472-4100
(571) 472-4101
Mailing address
PO BOX 37174, BALTIMORE, MD 21297-3174
(571) 423-5699
(571) 423-5698
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024172491
VA
363LA2200X
Adult Health Nurse Practitioner
0024172491
VA
Other
Enumeration date
03/30/2015
Last updated
10/24/2024
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