Individual
MILLICENT M MUTISYA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8613 ROUTE 29 # 200N, FAIRFAX, VA 22031-2171
(571) 350-8400
(703) 280-9596
Mailing address
3040 WILLIAMS DR STE 100, FAIRFAX, VA 22031-4618
(571) 350-8400
(703) 280-9596
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024180473
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285308528
—
VA
01
—
2H1702
MEDICARE PTAN
DC
Enumeration date
08/02/2021
Last updated
11/11/2025
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