Individual
STEPHANIE GWEN BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
102 HERITAGE WAY NE, SUITE 302, LEESBURG, VA 20176
(703) 771-5100
(703) 777-0170
Mailing address
102 HERITAGE WAY NE STE 302, LEESBURG, VA 20176-4544
(703) 771-5100
(703) 777-0170
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
0001257773
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005996510-03
TRICARE PRIME
—
Enumeration date
06/15/2017
Last updated
07/21/2022
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