| Doctor Name: | CRYSTAL ANN MCGOVERN |
| NPI Number: | 1063714244 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | N.P. |
| License Number: | 0024168953 |
| Business Practice Address: | 8640 Sudley Rd Suite 201 Manassas, VA - 201104420 |
| Business Phone Number: | 7033686819 |
| Business Fax Number: | 7033302923 |
| Mailing Address: | 8640 Sudley Rd, Ste 201 MANASSAS |
| State: | VA |
| Postal Code: | 201104404 |
| Phone Number: | 7033686819 |
| Fax Number: | 7033302923 |
| NPI Enumeration Date: | 11/22/2010 |
| NPI Last Update Date: | 04/11/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024168953 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |