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General NPI Number Information
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NPI Number | 1073494431
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Entity Type | Individual
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Provider Name | TESSA LI
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Gender |
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 3350 COMMISSION CT
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City | WOODBRIDGE
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State | VA
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Zip | 22192-1784
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Country | US
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Telephone | 703-680-7950
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Fax |
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Provider Business Mailing Address
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Address Line | 12880 MOSAIC PARK WAY UNIT S
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City | HERNDON
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State | VA
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Zip | 20171-5437
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | 0024191963
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License Number State | VA
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