Healthcare Provider Details

I. General information

NPI: 1134668155
Provider Name (Legal Business Name): TSION GEBRESELLASIE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2017
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 S WHITING ST STE 104
ALEXANDRIA VA
22304-3416
US

IV. Provider business mailing address

101 S WHITING ST STE 104
ALEXANDRIA VA
22304-3416
US

V. Phone/Fax

Practice location:
  • Phone: 703-362-3461
  • Fax: 703-574-7145
Mailing address:
  • Phone: 703-362-3461
  • Fax: 703-574-7145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number0024174331
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174331
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: