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1114621810
AMANDA LEE THACKER
LEESBURG, VA
NPI
1114621810
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: VA 0024185322)
Enumeration Date
2023-03-28
Last Update Date
2024-03-06
Business Address
AMANDA LEE THACKER FNP
19450 DEERFIELD AVENUE, SUITE 200
LEESBURG, VA 20176-6821
Phone number: 703-844-8380
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Mailing Address
AMANDA LEE THACKER FNP
224-D CORNWALL ST., NW SUITE 403
LEESBURG, VA 20176-2704
Phone number: 703-737-6010
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