Healthcare Provider Details

I. General information

NPI: 1679833271
Provider Name (Legal Business Name): SENTEW CARE NURSE PRACTITIONER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2012
Last Update Date: 05/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8322 BARK TREE CT
SPRINGFIELD VA
22153-3828
US

IV. Provider business mailing address

8322 BARK TREE CT
SPRINGFIELD VA
22153-3828
US

V. Phone/Fax

Practice location:
  • Phone: 202-670-2570
  • Fax: 202-800-2845
Mailing address:
  • Phone: 202-670-2570
  • Fax: 202-800-2845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN1003185
License Number StateDC

VIII. Authorized Official

Name: SENAIT TEWOLDE
Title or Position: NP
Credential: ANP-BC
Phone: 202-670-2570