Healthcare Provider Details

I. General information

NPI: 1194504068
Provider Name (Legal Business Name): REBECCA MENSAH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2023
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20130 LAKEVIEW CENTER PLZ STE 400
ASHBURN VA
20147-5905
US

IV. Provider business mailing address

1101 WILSON BLVD
ARLINGTON VA
22209-2211
US

V. Phone/Fax

Practice location:
  • Phone: 703-865-2144
  • Fax:
Mailing address:
  • Phone: 800-969-0912
  • Fax: 718-719-2891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024187872
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024187872
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number0024187872
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: