Healthcare Provider Details

I. General information

NPI: 1154180685
Provider Name (Legal Business Name): BRIANNA CRUTTENDEN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRIANNA NOLAN

II. Dates (important events)

Enumeration Date: 03/18/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

IV. Provider business mailing address

750 THORNTON WAY APT 525
ALEXANDRIA VA
22314-6518
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP1049012
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024189729
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: