Healthcare Provider Details

I. General information

NPI: 1508144189
Provider Name (Legal Business Name): SENAIT TEWOLDE ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2011
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3543 W BRADDOCK RD STE D3 4TH FLOOR
ALEXANDRIA VA
22302-1903
US

IV. Provider business mailing address

3543 W BRADDOCK RD
ALEXANDRIA VA
22302-1900
US

V. Phone/Fax

Practice location:
  • Phone: 703-567-4104
  • Fax: 571-376-6731
Mailing address:
  • Phone: 703-567-4104
  • Fax: 571-376-6731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024171191
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN1003185
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: