Individual ProviderEileen PetersonNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709(703) 391-3600PECOS EnrollmentBased on the most recent information from CMS, provider Eileen Peterson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1710917919Provider TypeIndividualFull NamePeterson, EileenCredentialCRNAGenderFemaleSole ProprietorNoEnumeration Date7/3/2006Last Updated6/20/2023Contact InformationPractice LocationPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709Phone(703) 391-3600Fax(703) 391-3414Mailing LocationMailing Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709PhoneUnlisted PhoneFaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense0024117346VirginiaProvider IdentifiersIDDescriptionIssuerID1710917919DescriptionMedicaidIssuerUnlistedVirginia