Individual
ANDREW LANE PRIMMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSA
Contact information
Practice address
8280 WILLOW OAKS CORPORATE DR, STE 641, FAIRFAX, VA 22031
(703) 659-4557
(703) 205-9010
Mailing address
8116 ARLINGTON BLVD STE 183, FALLS CHURCH, VA 22042-1002
(703) 659-4557
(703) 205-9010
Taxonomy
Speciality
Code
Description
License number
State
246ZC0007X
Surgical Assistant
Primary
0136000468
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
195631
NBSTSA
—
Enumeration date
03/22/2024
Last updated
03/22/2024
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