Healthcare Provider Details

I. General information

NPI: 1902527278
Provider Name (Legal Business Name): JESSICA MICHELLE GREENBERG-ENGLE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41816 FENWAY CIRCLE
ASHBURN VA
20148
US

IV. Provider business mailing address

41816 FENWAY CIR
ASHBURN VA
20148-8069
US

V. Phone/Fax

Practice location:
  • Phone: 703-424-6700
  • Fax:
Mailing address:
  • Phone: 703-424-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAG11210105
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024184055
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: