Healthcare Provider Details

I. General information

NPI: 1811106099
Provider Name (Legal Business Name): LEANNE MICCIO CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19490 SANDRIDGE WAY STE 350
LANSDOWNE VA
20176-3467
US

IV. Provider business mailing address

19490 SANDRIDGE WAY STE 350
LANSDOWNE VA
20176-3467
US

V. Phone/Fax

Practice location:
  • Phone: 703-858-5599
  • Fax: 703-858-5699
Mailing address:
  • Phone: 703-858-5599
  • Fax: 703-858-5699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number0024194631
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number25ME00033601
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: