Provider Demographics
NPI:1689331951
Name:DRAPER, SALLY (RN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:DRAPER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14554 LEE RD
Mailing Address - Street 2:
Mailing Address - City:CHANTILLY
Mailing Address - State:VA
Mailing Address - Zip Code:20151-1775
Mailing Address - Country:US
Mailing Address - Phone:602-650-1212
Mailing Address - Fax:
Practice Address - Street 1:14554 LEE RD
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1775
Practice Address - Country:US
Practice Address - Phone:602-650-1212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001114624163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse