Healthcare Provider Details

I. General information

NPI: 1700112596
Provider Name (Legal Business Name): ANISSA M BEN AIDA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2009
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 OLD CHAIN BRIDGE RD STE 101
MC LEAN VA
22101-3909
US

IV. Provider business mailing address

PO BOX 791775
BALTIMORE MD
21279-1775
US

V. Phone/Fax

Practice location:
  • Phone: 703-893-2273
  • Fax: 703-893-4559
Mailing address:
  • Phone: 571-302-5000
  • Fax: 571-302-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024168447
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: