| Doctor Name: | MISS MIKAELA JANE EGAN |
| NPI Number: | 1982949756 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | B.S. |
| License Number: | |
| Business Practice Address: | 11240 Waples Mill Rd Suite 202 Fairfax, VA - 220306078 |
| Business Phone Number: | 7035851095 |
| Business Fax Number: | |
| Mailing Address: | 11232 Chestnut Grove Sq, Unit 234 RESTON |
| State: | VA |
| Postal Code: | 201905157 |
| Phone Number: | 7032208930 |
| Fax Number: | |
| NPI Enumeration Date: | 12/05/2012 |
| NPI Last Update Date: | 12/05/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |