Healthcare Provider Details

I. General information

NPI: 1437007515
Provider Name (Legal Business Name): FAMILYNPLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4419 CORTEZ DR
FAIRFAX VA
22030-5308
US

IV. Provider business mailing address

4419 CORTEZ DR
FAIRFAX VA
22030-5308
US

V. Phone/Fax

Practice location:
  • Phone: 570-417-5308
  • Fax: 703-831-9332
Mailing address:
  • Phone: 570-417-5308
  • Fax: 703-831-9332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RENEE DANIELLE POESNECKER
Title or Position: OWNER
Credential: FNP
Phone: 570-417-5308