NPI 1992541890 · live from the CMS NPI Registry
Chantilly Wellness Group, LLC
Nurse Practitioner, Pediatrics in Chantilly, VA. National Provider Identifier 1992541890, active.
NPI record
| NPI | 1992541890 Type 2 · organization |
|---|---|
| Status | Active |
| Primary specialty | Nurse Practitioner, Pediatrics 363LP0200X |
| Practice location | 4200a Technology Ct, Chantilly, VA 20151 |
| Practice phone | 540-709-1737 |
| Enumerated | July 1, 2024 |
| Last updated | April 28, 2025 |
| Authorized official | Emily Derocco, Secretary |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Obstetrics & Gynecology | 207V00000X | — |
| Nurse Practitioner, Pediatrics primary | 363LP0200X | — |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.