Individual
MALLORY GILES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CPNP-PC
Contact information
Practice address
20955 PROFESSIONAL PLZ STE 200, ASHBURN, VA 20147-3405
(703) 729-7652
(703) 729-8746
Mailing address
224-D CORNWALL ST., NW, SUITE 403, LEESBURG, VA 20176-2704
(703) 737-6010
(703) 443-8643
Taxonomy
Speciality
Code
Description
License number
State
363LP0200X
Pediatric Nurse Practitioner
Primary
0024182192
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1417623497
—
VA
05
—
30016126720001
—
VA
Enumeration date
08/19/2021
Last updated
05/11/2026
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