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General NPI Number Information
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NPI Number | 1891044657
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Entity Type | Organization
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Legal Business Name | DRYNACHAN LLC
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Dates
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Enumeration Date | 09/07/2012
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 14121 PARKE LONG CT SUITE 201
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City | CHANTILLY
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State | VA
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Zip | 20151-1647
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Country | US
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Telephone | 571-449-3585
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Fax |
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Provider Business Mailing Address
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Address Line | 14121 PARKE LONG CT SUITE 201
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City | CHANTILLY
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State | VA
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Zip | 20151-1647
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Country | US
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Telephone | 571-449-3585
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. BRIAN J WISE
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Credential |
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Telephone | 571-449-2928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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