Individual
DOREEN MATTIMIRO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
19415 DEERFIELD AVE, SUITE 213, LANSDOWNE, VA 20176-8452
(703) 729-9220
(703) 858-3529
Mailing address
19415 DEERFIELD AVE, SUITE 213, LANSDOWNE, VA 20176-8452
(703) 729-9220
(703) 858-3529
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024091068
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010108276
—
VA
Enumeration date
01/18/2007
Last updated
07/09/2007
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