Healthcare Provider Details

I. General information

NPI: 1801405212
Provider Name (Legal Business Name): BRENDA SUE MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BRENDA SUE TOBIN RN

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 11/02/2020
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8320 OLD COURTHOUSE RD STE 400
VIENNA VA
22182-3848
US

IV. Provider business mailing address

8320 OLD COURTHOUSE RD STE 400
VIENNA VA
22182-3848
US

V. Phone/Fax

Practice location:
  • Phone: 703-226-4000
  • Fax: 703-226-4010
Mailing address:
  • Phone: 703-226-4000
  • Fax: 703-226-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0800X
TaxonomyNeuroscience Registered Nurse
License Number0001245334
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024180418
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: