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General NPI Number Information
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NPI Number | 1629607882
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Entity Type | Individual
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Provider Name | MELANIE HERRIN
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Gender | Female
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Dates
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Enumeration Date | 04/08/2020
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 6230 ROLLING RD STE J
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City | SPRINGFIELD
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State | VA
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Zip | 22152-2326
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Country | US
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Telephone | 571-665-6460
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Fax | 571-565-6561
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Provider Business Mailing Address
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Address Line | 315 WILKES ST
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3719
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Country | US
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Telephone | 703-307-1691
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 0024179126
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024179126
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License Number State | VA
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