Healthcare Provider Details

I. General information

NPI: 1417875600
Provider Name (Legal Business Name): MERON GETANEH LISANEWORK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2026
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8015 STEEPLE CHASE CT
SPRINGFIELD VA
22153-3607
US

IV. Provider business mailing address

8015 STEEPLE CHASE CT
SPRINGFIELD VA
22153-3607
US

V. Phone/Fax

Practice location:
  • Phone: 571-692-0696
  • Fax:
Mailing address:
  • Phone: 571-692-0696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number2656148
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: