Organization
FANNYPANTS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOPHIA PARKER (OWNER/CEO)
(703) 953-3099
Entity
Organization
Contact information
Practice address
4229 LAFAYETTE CENTER DR, SUITE 1150, CHANTILLY, VA 20151-1261
(703) 953-3099
(703) 956-6020
Mailing address
4229 LAFAYETTE CENTER DR, SUITE 1150, CHANTILLY, VA 20151-1261
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1329638
VA
Other
Enumeration date
10/23/2013
Last updated
10/23/2013
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