Individual
MISS MIKAELA JANE EGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
B.S.
Contact information
Practice address
11240 WAPLES MILL RD, SUITE 202, FAIRFAX, VA 22030-6078
(703) 585-1095
Mailing address
11232 CHESTNUT GROVE SQ, UNIT 234, RESTON, VA 20190-5157
(703) 220-8930
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
12/05/2012
Last updated
12/05/2012
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