Healthcare Provider Details

I. General information

NPI: 1023969417
Provider Name (Legal Business Name): EMILY DETTBARN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2026
Last Update Date: 10/02/2026
Certification Date: 10/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 ARLINGTON BLVD STE 500
FALLS CHURCH VA
22042-2325
US

IV. Provider business mailing address

4439 ROSENWALD LN
FAIRFAX VA
22030-5194
US

V. Phone/Fax

Practice location:
  • Phone: 703-533-5000
  • Fax: 703-533-0011
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024198237
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: