Healthcare Provider Details

I. General information

NPI: 1033668082
Provider Name (Legal Business Name): BRENDA NAKATO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2016
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10520 JUDICIAL DR
FAIRFAX VA
22030-5115
US

IV. Provider business mailing address

10520 JUDICIAL DR
FAIRFAX VA
22030-5115
US

V. Phone/Fax

Practice location:
  • Phone: 571-567-2232
  • Fax:
Mailing address:
  • Phone: 571-567-2232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024196335
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: