Healthcare Provider Details

I. General information

NPI: 1053754754
Provider Name (Legal Business Name): CYNTHIA ANN LEAVER PHD, RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA ANN ANDREWS RN, MSN, FNP-BC

II. Dates (important events)

Enumeration Date: 04/11/2013
Last Update Date: 04/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 WESTPARK DR
MC LEAN VA
22102-3109
US

IV. Provider business mailing address

3916 RIVE DR
ALEXANDRIA VA
22309-3031
US

V. Phone/Fax

Practice location:
  • Phone: 703-287-6442
  • Fax:
Mailing address:
  • Phone: 703-969-3661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168593
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: