Healthcare Provider Details

I. General information

NPI: 1316241854
Provider Name (Legal Business Name): DOREEN FAYE GRZELAK NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOREEN FAYE CHAFFINCH RN

II. Dates (important events)

Enumeration Date: 12/24/2010
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44035 RIVERSIDE PKWY STE 300
LEESBURG VA
20176-8260
US

IV. Provider business mailing address

3040 WILLIAMS DR STE 100
FAIRFAX VA
22031-4618
US

V. Phone/Fax

Practice location:
  • Phone: 703-554-6800
  • Fax: 703-724-7503
Mailing address:
  • Phone: 571-350-8400
  • Fax: 703-940-8697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024168894
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: