Healthcare Provider Details

I. General information

NPI: 1699655514
Provider Name (Legal Business Name): NORMANDIE OROSA GRUTA BS, RNFA, CNOR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2025
Last Update Date: 09/03/2025
Certification Date: 09/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4320 SEMINARY RD
ALEXANDRIA VA
22304-1535
US

IV. Provider business mailing address

2775 MAPLE RIDGE DR
WOODBRIDGE VA
22192-3808
US

V. Phone/Fax

Practice location:
  • Phone: 703-504-3510
  • Fax:
Mailing address:
  • Phone: 703-801-3286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number0001145053
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: