Individual
AMANDA MARIE SALLBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
200 NORTH MAPLE AVENUE, PURCELLVILLE, VA 20132-6100
(540) 338-0177
Mailing address
224-D CORNWALL STREET, NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024188783
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1295597672
—
VA
05
—
30017805730001
—
VA
Enumeration date
01/30/2024
Last updated
04/17/2024
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