NPI 1285330183 · live from the CMS NPI Registry
Mackenzie Box
Nurse Practitioner, Pediatrics in Reston, VA. National Provider Identifier 1285330183, active.
NPI record
| NPI | 1285330183 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 1830 Town Center Dr Ste 205, Reston, VA 20190 |
| Practice phone | 703-435-3636 |
| Mailing address | 4060 Gateway Dr Apt 5233, Fairfax, VA 22030 |
| Enumerated | February 1, 2023 |
| Last updated | October 20, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Nurse Practitioner, Pediatrics primary | 363LP0200X | 0024186498 (VA) |
| Registered Nurse | 163W00000X | 0001317538 (VA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.