MEDICARE: LEILING CHEN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	0024182305	VA

General Provider Information

NPI Number	:	1174298400
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEILING CHEN FNP

Provider Business Mailing Address
First Line	:	25284 PLANTING FIELD DR
Second Line	:
City	:	CHANTILLY
State	:	VA
Zip	:	20152-4459
Country	:	US
Telephone Number	:	203-823-8136
Fax Number	:

Provider Business Practice Location Address
First Line	:	10329 DEMOCRACY LN
Second Line	:	STE B
City	:	FAIRFAX
State	:	VA
Zip	:	22030-2559
Country	:	US
Telephone Number	:	203-823-8136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	01/11/2022

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