Healthcare Provider Details

I. General information

NPI: 1720457047
Provider Name (Legal Business Name): LINDSAY LIWANAG FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2015
Last Update Date: 01/27/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 LAFAYETTE CENTER DR STE. 170
CHANTILLY VA
20151-1247
US

IV. Provider business mailing address

4080 LAFAYETTE CENTER DR STE. 170
CHANTILLY VA
20151-1247
US

V. Phone/Fax

Practice location:
  • Phone: 703-766-5040
  • Fax:
Mailing address:
  • Phone: 703-766-5040
  • Fax: 703-766-5047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172889
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024172889
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: