Individual
MRS. BRANDI RENEE FOSSUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ACNPC-AG, RNFA, CNOR
Contact information
Practice address
14605 POTOMAC BRANCH DR, WOODBRIDGE, VA 22191-3336
(703) 490-1112
(703) 878-8735
Mailing address
14605 POTOMAC BRANCH DR, WOODBRIDGE, VA 22191-3336
(703) 490-1112
(703) 878-8735
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001219358
VA
163WR0006X
Registered Nurse First Assistant
0001219358
VA
363LA2100X
Acute Care Nurse Practitioner
Primary
0024178671
VA
Other
Enumeration date
04/21/2014
Last updated
01/24/2020
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