Healthcare Provider Details

I. General information

NPI: 1063324150
Provider Name (Legal Business Name): STEPHANIE DANIEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2026
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13410 LAWRENCE LN
BRISTOW VA
20136-1702
US

IV. Provider business mailing address

13410 LAWRENCE LN
BRISTOW VA
20136-1702
US

V. Phone/Fax

Practice location:
  • Phone: 703-967-2657
  • Fax:
Mailing address:
  • Phone: 703-967-2657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number179061197
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: