Healthcare Provider Details

I. General information

NPI: 1467620047
Provider Name (Legal Business Name): JAYNE DAPHNE JAMES M.S.N., APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 CAMERON GLEN DR
RESTON VA
20190-3363
US

IV. Provider business mailing address

10515 MANOR VIEW PL
MANASSAS VA
20110-6620
US

V. Phone/Fax

Practice location:
  • Phone: 703-326-3165
  • Fax:
Mailing address:
  • Phone: 703-392-7844
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number0015000852
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: