Organization
BRISTOW RUN FAMILY MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER M STALEY FNP (FAMILY NURSE PRACTITIONER)
(919) 538-1712
Entity
Organization
Contact information
Practice address
14540 JOHN MARSHALL HWY, #104, GAINESVILLE, VA 20155-1691
(703) 753-9799
Mailing address
1134 S THOMAS ST APT 1, ARLINGTON, VA 22204-3621
(919) 538-1712
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
0024173774
VA
Other
Enumeration date
07/26/2016
Last updated
07/26/2016
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