Healthcare Provider Details

I. General information

NPI: 1578590428
Provider Name (Legal Business Name): RAN YANG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 11/27/2023
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21785 FILIGREE CT SUITE 100
ASHBURN VA
20147-6213
US

IV. Provider business mailing address

21785 FILIGREE CT SUITE 100
ASHBURN VA
20147-6213
US

V. Phone/Fax

Practice location:
  • Phone: 703-554-1100
  • Fax: 703-554-1110
Mailing address:
  • Phone: 703-554-1100
  • Fax: 703-554-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001165297
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024166392
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: