Provider Demographics
NPI:1649945593
Name:KONISHI, MARISA (FNP)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:
Last Name:KONISHI
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13168 CENTERPOINTE WAY STE 101
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5287
Mailing Address - Country:US
Mailing Address - Phone:703-730-2000
Mailing Address - Fax:
Practice Address - Street 1:1800 TOWN CENTER DR STE 311
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3239
Practice Address - Country:US
Practice Address - Phone:703-763-2705
Practice Address - Fax:833-907-2320
Is Sole Proprietor?:No
Enumeration Date:2021-08-12
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024181654363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily