Healthcare Provider Details

I. General information

NPI: 1831528991
Provider Name (Legal Business Name): MEGHAN GLASSMACHER CROMWELL CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2013
Last Update Date: 10/06/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8316 TRADFORD LANE STE 1
SPRINGFIELD VA
22152-4329
US

IV. Provider business mailing address

13901 STONEFIELD DR
CLIFTON VA
20124-2551
US

V. Phone/Fax

Practice location:
  • Phone: 703-569-8400
  • Fax: 703-569-1182
Mailing address:
  • Phone: 703-927-5985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024173186
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: