Provider Demographics
NPI:1053556175
Name:FRICKEL, MARY JOSEPH (CFNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:JOSEPH
Last Name:FRICKEL
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:224-D CORNWALL ST., NW SUITE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:1800 TOWN CENTER DRIVE, SUITE 220
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3238
Practice Address - Country:US
Practice Address - Phone:703-435-2555
Practice Address - Fax:571-926-8910
Is Sole Proprietor?:No
Enumeration Date:2008-12-03
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024121397363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1053556175Medicaid
VA30015909410002Medicaid