Healthcare Provider Details

I. General information

NPI: 1063346633
Provider Name (Legal Business Name): OLIVIA SARAH GRINNELL EGAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13198 JAMES MADISON HWY
ORANGE VA
22960-2808
US

IV. Provider business mailing address

13198 JAMES MADISON HWY
ORANGE VA
22960-2808
US

V. Phone/Fax

Practice location:
  • Phone: 540-672-3010
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: