Provider Demographics
NPI:1316241854
Name:GRZELAK, DOREEN FAYE (NP-C)
Entity type:Individual
Prefix:MS
First Name:DOREEN
Middle Name:FAYE
Last Name:GRZELAK
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MS
Other - First Name:DOREEN
Other - Middle Name:FAYE
Other - Last Name:CHAFFINCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3040 WILLIAMS DR STE 100
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22031-4618
Mailing Address - Country:US
Mailing Address - Phone:571-350-8400
Mailing Address - Fax:703-940-8697
Practice Address - Street 1:44035 RIVERSIDE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-8260
Practice Address - Country:US
Practice Address - Phone:703-554-6800
Practice Address - Fax:703-724-7503
Is Sole Proprietor?:No
Enumeration Date:2010-12-24
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024168894363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC489421ZAN3OtherMEDICARE PTAN
VA1316241854Medicaid
VAVVY852AOtherMEDICARE PTAN