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Organization
DRYNACHAN LLC
Active
Organization
DRYNACHAN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN J WISE (CEO)
(571) 449-2928
Entity
Organization
Contact information
Practice address
14121 PARKE LONG CT, SUITE 201, CHANTILLY, VA 20151-1647
(571) 449-3585
Mailing address
14121 PARKE LONG CT, SUITE 201, CHANTILLY, VA 20151-1647
(571) 449-3585
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
—
NULL
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003185092A
—
GA
05
—
18159900
—
FL
05
—
1891044657
—
WA
05
—
1891055657
—
IL
05
—
1991044657
—
VA
05
—
300001898
—
IN
05
—
500040770
—
MO
05
—
GP7738
—
SC
Enumeration date
09/07/2012
Last updated
03/26/2018
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