Provider Demographics
NPI:1538416292
Name:DILIBERTO, NADINE (NP)
Entity type:Individual
Prefix:
First Name:NADINE
Middle Name:
Last Name:DILIBERTO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9520 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3132
Mailing Address - Country:US
Mailing Address - Phone:703-425-8616
Mailing Address - Fax:
Practice Address - Street 1:9520 BURKE RD
Practice Address - Street 2:BURKE, VIRGINIA 22015
Practice Address - City:BURKE
Practice Address - State:VA
Practice Address - Zip Code:22015-3132
Practice Address - Country:US
Practice Address - Phone:703-425-8616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-12
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1011896363LF0000X
VA0024170035363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily