Healthcare Provider Details

I. General information

NPI: 1679325971
Provider Name (Legal Business Name): BEZA MESFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2024
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1313 DOLLEY MADISON BOULEVARD, SUITE 104
MCLEAN VA
22101-3926
US

IV. Provider business mailing address

224-D CORNWALL STREET, NW, STE 403
LEESBURG, VA VA
20176-2704
US

V. Phone/Fax

Practice location:
  • Phone: 703-263-8282
  • Fax: 571-378-0889
Mailing address:
  • Phone: 703-737-6010
  • Fax: 703-443-8643

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022094539
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: