Individual
MS. CARILLON S VELTSISTAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
3600 JOSEPH SIEWICK DR, FAIRFAX, VA 22033-1709
(703) 391-3129
(703) 391-3006
Mailing address
3998 FAIR RIDGE DR, SUITE 300, FAIRFAX, VA 22033-2907
(703) 295-9360
(703) 766-9725
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
0024124925
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
139230
TRIGON
VA
05
—
1740374602
—
VA
01
—
484645
NCPPO
VA
01
—
K142-0002
CARE FIRST 2005
VA
Enumeration date
10/03/2006
Last updated
03/30/2015
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