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General NPI Number Information
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NPI Number | 1235917170
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Entity Type | Organization
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Legal Business Name | NORTHERN VIRGINIA CAMP HEALTH SERVICES LLC
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Dates
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Enumeration Date | 09/21/2023
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Last Update Date | 05/30/2024
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Provider Practice Location Address
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Address Line | 6715 LITTLE RIVER TPKE STE 205
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City | ANNANDALE
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State | VA
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Zip | 22003-3546
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Country | US
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Telephone | 410-870-9380
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Fax |
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Provider Business Mailing Address
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Address Line | 6715 LITTLE RIVER TPKE STE 205
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City | ANNANDALE
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State | VA
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Zip | 22003-3546
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Country | US
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Telephone | 410-870-9380
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Fax |
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | MS. KRYSTLE BROWN
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Credential |
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Telephone | 410-870-9380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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