Healthcare Provider Details

I. General information

NPI: 1154593432
Provider Name (Legal Business Name): ROBERT VOLLBRECHT ANP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 08/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 OPITZ BLVD SENTARA NORTHERN VIRGINIA MEDICAL CENTER
WOODBRIDGE VA
22191-3311
US

IV. Provider business mailing address

2296 OPITZ BLVD SUITE 130
WOODBRIDGE VA
22191-3300
US

V. Phone/Fax

Practice location:
  • Phone: 703-523-0660
  • Fax:
Mailing address:
  • Phone: 703-523-0660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024167733
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: