Healthcare Provider Details

I. General information

NPI: 1831723485
Provider Name (Legal Business Name): NANA AGYEIWAA TETTEH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2020
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 FETTLER PARK DR
DUMFRIES VA
22025-2050
US

IV. Provider business mailing address

3700 FETTLER PARK DR
DUMFRIES VA
22025-2050
US

V. Phone/Fax

Practice location:
  • Phone: 703-441-7656
  • Fax:
Mailing address:
  • Phone: 703-441-7656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024178340
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: