Provider Demographics
NPI:1780202820
Name:GRAHAM, BRITTANY S (AG-ACNP)
Entity Type:Individual
Prefix:
First Name:BRITTANY
Middle Name:S
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:A
Other - Last Name:GRAHAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15262 BOWMANS FOLLY DR
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5451
Mailing Address - Country:US
Mailing Address - Phone:703-565-6246
Mailing Address - Fax:
Practice Address - Street 1:3300 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22042-3307
Practice Address - Country:US
Practice Address - Phone:703-776-3582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179624363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine