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General NPI Number Information
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NPI Number | 1669131645
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Entity Type | Individual
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Provider Name | OLIVIA LE
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Gender | Female
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Dates
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Enumeration Date | 12/16/2021
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Last Update Date | 04/07/2022
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Provider Practice Location Address
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Address Line | 3903 FAIR RIDGE DR STE 209
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City | FAIRFAX
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State | VA
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Zip | 22033-2944
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Country | US
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Telephone | 703-424-9676
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Fax |
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Provider Business Mailing Address
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Address Line | 14276 LADDERBACKED DR
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City | GAINESVILLE
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State | VA
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Zip | 20155-5919
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Country | US
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Telephone |
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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 | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number | 0024182153
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024182153
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License Number State | VA
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