NPI 1417076829 · live from the CMS NPI Registry
Minuteclinic Diagnostic Of Virginia LLC
Nurse Practitioner, Family in Leesburg, VA. National Provider Identifier 1417076829, active.
NPI record
| NPI | 1417076829 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Family 363LF0000X |
| Practice location | 19305 Ruby Dr, Leesburg, VA 20176 |
| Practice phone | 866-389-2727 |
| Mailing address | Po Box 772, Minuteclinic Credentialing-Mc2295, Woonsocket, RI 02895 |
| Enumerated | March 28, 2007 |
| Last updated | June 24, 2024 |
| Authorized official | Deborah Pincince, Administrator |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Counselor, Professional | 101YP2500X | — |
| Social Worker, Clinical | 1041C0700X | — |
| Marriage & Family Therapist | 106H00000X | — |
| Nurse Practitioner, Family primary | 363LF0000X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.