Provider Demographics
NPI:1902111446
Name:MCMAHON, ELIZABETH V (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:V
Last Name:MCMAHON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12011 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 504
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3310
Mailing Address - Country:US
Mailing Address - Phone:703-391-2030
Mailing Address - Fax:703-273-3943
Practice Address - Street 1:22895 BRAMBLETON PLZ
Practice Address - Street 2:SUITE 200
Practice Address - City:BRAMBLETON
Practice Address - State:VA
Practice Address - Zip Code:20148-4876
Practice Address - Country:US
Practice Address - Phone:703-722-2312
Practice Address - Fax:703-722-2317
Is Sole Proprietor?:No
Enumeration Date:2010-08-09
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0024168935363LF0000X
NC0024168935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1922008291Medicaid
VAVAA113262Medicare PIN