Healthcare Provider Details

I. General information

NPI: 1790897122
Provider Name (Legal Business Name): HARRIET VAUGHN GREENFIELD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/08/2024
Certification Date: 11/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12656A LAKE RIDGE DR STE A
LAKE RIDGE VA
22192-2335
US

IV. Provider business mailing address

12656 LAKE RIDGE DR STE A
LAKE RIDGE VA
22192-7504
US

V. Phone/Fax

Practice location:
  • Phone: 571-427-2095
  • Fax: 320-238-7553
Mailing address:
  • Phone: 571-427-2095
  • Fax: 320-238-7553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024167038
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: