Healthcare Provider Details

I. General information

NPI: 1508493685
Provider Name (Legal Business Name): MEENA DASWANI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/26/2020
Certification Date: 03/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7540 LITTLE RIVER TPKE STE H
ANNANDALE VA
22003-2839
US

IV. Provider business mailing address

301 N BEAUREGARD ST APT 301
ALEXANDRIA VA
22312-2909
US

V. Phone/Fax

Practice location:
  • Phone: 703-256-2600
  • Fax:
Mailing address:
  • Phone: 757-560-1802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178640
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: