Provider Demographics
NPI:1730320607
Name:VANWICKLER, BRITTANY L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:BRITTANY
Middle Name:L
Last Name:VANWICKLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8078 CRESCENT PARK DR STE 201
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20155-3449
Mailing Address - Country:US
Mailing Address - Phone:703-753-4999
Mailing Address - Fax:703-753-5915
Practice Address - Street 1:15237 CREATIVITY DR STE 301
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-2504
Practice Address - Country:US
Practice Address - Phone:540-321-4281
Practice Address - Fax:540-321-4282
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110002977363A00000X, 363AM0700X
VA0101235679363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1730320607Medicaid