Healthcare Provider Details

I. General information

NPI: 1992209993
Provider Name (Legal Business Name): NATALIA F BRIGHAM PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2018
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8221 WILLOW OAKS CORPORATE DR # 4-420
FAIRFAX VA
22031-4512
US

IV. Provider business mailing address

8221 WILLOW OAKS CORPORATE DR # 4-420
FAIRFAX VA
22031-4512
US

V. Phone/Fax

Practice location:
  • Phone: 703-289-7560
  • Fax: 703-204-9001
Mailing address:
  • Phone: 703-289-7560
  • Fax: 703-204-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024175992
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024175992
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: