Healthcare Provider Details

I. General information

NPI: 1548726326
Provider Name (Legal Business Name): BRITTANY BOONE LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2019
Last Update Date: 02/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 PEGASUS CT STE 500
WINCHESTER VA
22602-4596
US

IV. Provider business mailing address

774 WINDY WAY
FRONT ROYAL VA
22630-6067
US

V. Phone/Fax

Practice location:
  • Phone: 540-313-4196
  • Fax: 540-686-7906
Mailing address:
  • Phone: 540-551-0040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0002087469
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: