Healthcare Provider Details

I. General information

NPI: 1104220813
Provider Name (Legal Business Name): GIGI ELISABETH DANN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GIGI ELISABETH LECLEAR FNP

II. Dates (important events)

Enumeration Date: 10/09/2014
Last Update Date: 03/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9430 FORESTWOOD LN STE 100
MANASSAS VA
20110-4754
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 703-365-0227
  • Fax:
Mailing address:
  • Phone: 844-266-8268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024172102
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172102
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number0001162246
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: