Healthcare Provider Details

I. General information

NPI: 1679052211
Provider Name (Legal Business Name): BLESSING OWUSU LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 LITTLE RIVER TPKE STE 600
ANNANDALE VA
22003-2628
US

IV. Provider business mailing address

7619 LITTLE RIVER TPKE STE 600
ANNANDALE VA
22003-2628
US

V. Phone/Fax

Practice location:
  • Phone: 703-752-8741
  • Fax: 703-752-8746
Mailing address:
  • Phone: 703-752-8741
  • Fax: 703-752-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2083876
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: