Provider Demographics
NPI:1124824230
Name:NAYLOR, ILLANA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:ILLANA
Middle Name:
Last Name:NAYLOR
Suffix:
Gender:
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10294 S GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-6135
Mailing Address - Country:US
Mailing Address - Phone:703-975-9510
Mailing Address - Fax:
Practice Address - Street 1:10294 S GRANT AVE
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-6135
Practice Address - Country:US
Practice Address - Phone:703-975-9510
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001096064163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool