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General NPI Number Information
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NPI Number | 1205826617
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Entity Type | Individual
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Provider Name | MISS NANCY JO LEAGUE
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Gender | Female
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Dates
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Enumeration Date | 10/26/2005
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Last Update Date | 07/13/2026
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Provider Practice Location Address
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Address Line | 9501 FARRELL RD
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City | FORT BELVOIR
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State | VA
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Zip | 22060-5901
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Country | US
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Telephone | 703-805-0989
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Fax |
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Provider Business Mailing Address
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Address Line | 159 ANTIQUA PL
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City | EDGEWATER
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State | MD
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Zip | 21037-2768
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Country | US
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Telephone | 410-798-1753
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 664062
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License Number State | TX
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