Healthcare Provider Details

I. General information

NPI: 1629835541
Provider Name (Legal Business Name): AMANDA ELAINE LANGKOP WANAT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16712 JEFFERSON DAVIS HWY
DUMFRIES VA
22026-2115
US

IV. Provider business mailing address

5049 7TH RD S APT 202
ARLINGTON VA
22204-2521
US

V. Phone/Fax

Practice location:
  • Phone: 703-221-7467
  • Fax:
Mailing address:
  • Phone: 972-904-8562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1153289
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024189661
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: