Individual ProviderDelisa D HallNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709(703) 391-3129(703) 295-9360PECOS EnrollmentBased on the most recent information from CMS, provider Delisa D Hall 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 yesterday at 9:15 AM.Profile DetailsProvider ID1811080856Provider TypeIndividualFull NameHall, Delisa DTitleMs.CredentialCRNAGenderFemaleSole ProprietorNoEnumeration Date10/2/2006Last Updated3/20/2015Contact InformationPractice LocationPractice Address3600 Joseph Siewick Dr, Fairfax, VA 22033-1709Phone(703) 391-3129Fax(703) 391-3006Mailing LocationMailing Address3998 Fair Ridge Rd, Suite 300, Fairfax, VA 22033-2921Phone(703) 295-9360Fax(703) 766-9725Provider TaxonomiesCodeDescriptionLicenseCode367500000XPrimaryDescriptionNurse Anesthetist, Certified RegisteredPhysician Assistants & Advanced Practice Nursing ProvidersLicense0024166862VirginiaProvider IdentifiersIDDescriptionIssuerIDK142-0002DescriptionOtherIssuerCAREFIRSTDistrict of ColumbiaID484645DescriptionOtherIssuerNCPPOVirginiaID1811080856DescriptionMedicaidIssuerUnlistedVirginiaID301858DescriptionOtherIssuerAMERIGROUPVirginiaID139180DescriptionOtherIssuerANTHEMVirginia