Individual
ISABELLA MICHELLE LAVISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6355 WALKER LANE, SUITE 308, ALEXANDRIA, VA 22310-3247
(703) 313-7700
(703) 313-0178
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110010548
VA
363A00000X
Physician Assistant
PA200001769
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30017725180001
—
VA
Enumeration date
07/27/2023
Last updated
01/19/2025
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