Healthcare Provider Details

I. General information

NPI: 1538409305
Provider Name (Legal Business Name): CHRISTINA LYNDA ROSENBERG APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2013
Last Update Date: 11/27/2023
Certification Date: 10/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3914 CENTREVILLE RD STE 250
CHANTILLY VA
20151-3290
US

IV. Provider business mailing address

3914 CENTREVILLE RD STE 250
CHANTILLY VA
20151-3290
US

V. Phone/Fax

Practice location:
  • Phone: 703-435-1223
  • Fax: 703-435-1868
Mailing address:
  • Phone: 703-435-1223
  • Fax: 703-435-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174341
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60453134
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: