Healthcare Provider Details

I. General information

NPI: 1255691168
Provider Name (Legal Business Name): MANMOHAN K GILL FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MANMOHAN K GILL FNP

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1043 STERLING RD STE 104
HERNDON VA
20170-3842
US

IV. Provider business mailing address

1043 STERLING RD SUITE 104
HERNDON VA
20170-3866
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-0111
  • Fax: 703-689-0077
Mailing address:
  • Phone: 703-689-0111
  • Fax: 703-689-0077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001189983
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024169989
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: