Healthcare Provider Details

I. General information

NPI: 1194326595
Provider Name (Legal Business Name): MICHELLE ANNE STANLEY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 12/12/2021
Certification Date: 12/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20925 PROFESSIONAL PLZ STE 230
ASHBURN VA
20147-3403
US

IV. Provider business mailing address

20925 PROFESSIONAL PLZ STE 230
ASHBURN VA
20147-3403
US

V. Phone/Fax

Practice location:
  • Phone: 703-621-7121
  • Fax:
Mailing address:
  • Phone: 703-621-7121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number107515
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024180260
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: