Provider Demographics
NPI:1366807539
Name:OLLIS, EMILY NICOLE (FNP)
Entity type:Individual
Prefix:MS
First Name:EMILY
Middle Name:NICOLE
Last Name:OLLIS
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 1:3835 9TH ST N
Mailing Address - Street 2:APT 604E
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-1931
Mailing Address - Country:US
Mailing Address - Phone:240-678-2438
Mailing Address - Fax:
Practice Address - Street 1:12018 SUNRISE VALLEY DR
Practice Address - Street 2:STE 400
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191-3432
Practice Address - Country:US
Practice Address - Phone:571-262-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173063363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily