Healthcare Provider Details

I. General information

NPI: 1548417959
Provider Name (Legal Business Name): AYANA ALEXIS HABTEMARIAM R.D., L.D.N
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AYANA POWELL

II. Dates (important events)

Enumeration Date: 08/27/2008
Last Update Date: 06/08/2023
Certification Date: 06/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4001 9TH ST N STE 220
ARLINGTON VA
22203-1900
US

IV. Provider business mailing address

4001 9TH ST N STE 220
ARLINGTON VA
22203-1900
US

V. Phone/Fax

Practice location:
  • Phone: 703-656-6631
  • Fax: 703-997-4108
Mailing address:
  • Phone: 703-656-6631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number00985931
License Number State
# 3
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License NumberDN003836
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: