Provider Demographics
NPI:1740932748
Name:WHITNEY, AMANDA FAITH
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:FAITH
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9217 BURKE RD
Mailing Address - Street 2:
Mailing Address - City:BURKE
Mailing Address - State:VA
Mailing Address - Zip Code:22015-3315
Mailing Address - Country:US
Mailing Address - Phone:540-446-8922
Mailing Address - Fax:
Practice Address - Street 1:3650 JOSEPH SIEWICK DR STE 204
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22033-1712
Practice Address - Country:US
Practice Address - Phone:703-264-0521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024183253363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily