Healthcare Provider Details

I. General information

NPI: 1891170833
Provider Name (Legal Business Name): MECHELLE LEDWITH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2015
Last Update Date: 11/27/2023
Certification Date: 10/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6230 ROLLING RD SUITE J
SPRINGFIELD VA
22152-2307
US

IV. Provider business mailing address

6230 ROLLING RD SUITE J
SPRINGFIELD VA
22152-2307
US

V. Phone/Fax

Practice location:
  • Phone: 571-665-6460
  • Fax:
Mailing address:
  • Phone: 571-665-6460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172758
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: