Provider Demographics
NPI:1083609580
Name:BRANDQUIST, MARGARET JEANNE (CNM)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:JEANNE
Last Name:BRANDQUIST
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224-D CORNWALL ST, NW SUITE 403
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-2704
Mailing Address - Country:US
Mailing Address - Phone:703-737-6010
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:24430 STONE SPRINGS BLVD
Practice Address - Street 2:SUITE 550
Practice Address - City:DULLES
Practice Address - State:VA
Practice Address - Zip Code:20166
Practice Address - Country:US
Practice Address - Phone:703-957-1245
Practice Address - Fax:703-665-2374
Is Sole Proprietor?:No
Enumeration Date:2005-09-12
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024095834367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1083609580Medicaid
VA30015461020001Medicaid
P43708Medicare UPIN
VA014670L19Medicare PIN