Provider Demographics
NPI:1518384809
Name:GILLWALD, MADELEINE MARGARET (FNP)
Entity Type:Individual
Prefix:MRS
First Name:MADELEINE
Middle Name:MARGARET
Last Name:GILLWALD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MADELEINE
Other - Middle Name:MARGARET
Other - Last Name:GAWNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:4600 LANGSTON BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22207
Mailing Address - Country:US
Mailing Address - Phone:571-977-5274
Mailing Address - Fax:
Practice Address - Street 1:4600 LANGSTON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207
Practice Address - Country:US
Practice Address - Phone:571-492-3080
Practice Address - Fax:571-492-3081
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1019855163W00000X
VA0024174872363LF0000X
VA0001241677163WC0200X, 163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care