Individual
MRS. JUDY GENTRY CORCORAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.F.N.P.
Contact information
Practice address
9430 FORESTWOOD LANE, #100, MANASSAS, VA 20110
(703) 365-0227
(703) 365-0332
Mailing address
9430 FORESTWOOD LANE, #100, MANASSAS, VA 20110
(703) 365-0227
(703) 365-0332
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
0024164084
VA
363LF0000X
Family Nurse Practitioner
Primary
0024164084
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1326161134
—
VA
Enumeration date
04/08/2007
Last updated
07/27/2016
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