Individual provider Active NPI

Lindsay Liwanag, FNP-BC

  • Nurse Practitioner
  • Chantilly, VA
National Provider Identifier
1720457047
Registry record updated Jan 27, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
0024172889 Issued in VA
Practice address
4080 Lafayette Center Dr
Ste. 170
Chantilly, VA 20151-1247
Phone
(703) 766-5040
NPI assigned
Sep 16, 2015
Last updated
Jan 27, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 0024172889 VA Primary
Family Nurse Practitioner 363LF0000X 0024172889 VA

Addresses

Primary practice location

4080 Lafayette Center Dr
Ste. 170
Chantilly, VA 20151-1247

Mailing address

4080 Lafayette Center Dr
Ste. 170
Chantilly, VA 20151-1247
Phone (703) 766-5040

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151029002009 DC Practitioner - Nurse Practitioner 3072823269 Reassigns benefits to 2 organizations
I20170502000721 VA Practitioner - Nurse Practitioner 3072823269 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Psychogeriatric Services LLCGroup PAC ID 6002719226, 122 clinicians

Practice addresses (Care Compare)

12073 Tech Rd
Suite B
Silver Spring, MD 20904-7874
Phone (301) 593-1315

8575 Rixlew LN
Manassas, VA 20109-3701
Phone (301) 593-1315

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024172889VAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Privia Medical Group, LLC CurrentSince Sep 15, 2015 Accepting new patients
Psychogeriatric Services LLC Nurse Practitioner CurrentSince Jul 13, 2021 Accepting new patients
Privia Medical Group, LLC CurrentSince Sep 15, 2015 Accepting new patients

Locations

9470 Annapolis Rd
Ste 309
Lanham, MD 20706
Phone (202) 832-1800

12073 Tech Rd
Ste B
Silver Spring, MD 20904
Phone (240) 396-5873

4080 Lafayette Center Dr
Ste 170
Chantilly, VA 20151
Phone (703) 327-9773

8575 Rixlew Ln
Manassas, VA 20109
Phone (703) 257-9770

8644 Sudley Rd
#220
Manassas, VA 20110

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442361600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737936000000",
    "number": "1720457047",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4080 LAFAYETTE CENTER DR",
            "address_2": "STE. 170",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511247",
            "telephone_number": "703-766-5040",
            "fax_number": "703-766-5047"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4080 LAFAYETTE CENTER DR",
            "address_2": "STE. 170",
            "city": "CHANTILLY",
            "state": "VA",
            "postal_code": "201511247",
            "telephone_number": "703-766-5040"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LIWANAG",
        "first_name": "LINDSAY",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-16",
        "last_updated": "2025-01-27",
        "certification_date": "2025-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "VA",
            "license": "0024172889",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "VA",
            "license": "0024172889",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chantilly, VA

Sources for this page

Verify at the official NPI Registry.