Healthcare Provider Details

I. General information

NPI: 1962207027
Provider Name (Legal Business Name): GWENDOLYN BERWICK OLIPHANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2025
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 GALLOWS RD
FALLS CHURCH VA
22042-3300
US

IV. Provider business mailing address

2322 S COLUMBUS ST
ARLINGTON VA
22206-1025
US

V. Phone/Fax

Practice location:
  • Phone: 703-776-4001
  • Fax:
Mailing address:
  • Phone: 571-296-7198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0003X
TaxonomyInpatient Obstetric Registered Nurse
License Number0001257813
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024193978
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: