Doctor Name: | JOHNSIE CLERVEAU |
NPI Number: | 1134580269 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-C |
License Number: | 0024173105 |
Business Practice Address: | 14121 Parke Long Ct Ste 201 Chantilly, VA - 201511647 |
Business Phone Number: | 7578179532 |
Business Fax Number: | |
Mailing Address: | 14121 Parke Long Ct Ste 201, CHANTILLY |
State: | VA |
Postal Code: | 201511647 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 03/17/2016 |
NPI Last Update Date: | 03/17/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 0024173105 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |