Individual
KELLEY M MANAHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
8988 LORTON STATION BLVD, SUITE 100, LORTON, VA 22079-4756
(703) 780-2800
(703) 780-0461
Mailing address
8988 LORTON STATION BLVD, SUITE 100, LORTON, VA 22079-4756
(703) 780-2800
(703) 780-0461
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0024171028
VA
Other
Enumeration date
08/06/2013
Last updated
08/06/2013
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