Healthcare Provider Details

I. General information

NPI: 1366068801
Provider Name (Legal Business Name): GLORY NGOH TANYI PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2020
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 SLEEPY HOLLOW RD STE B
FALLS CHURCH VA
22044-2082
US

IV. Provider business mailing address

2960 SLEEPY HOLLOW RD STE B
FALLS CHURCH VA
22044-2082
US

V. Phone/Fax

Practice location:
  • Phone: 703-536-2000
  • Fax:
Mailing address:
  • Phone: 703-536-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1049594
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN1049594
License Number StateDC
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024196155
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: