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General NPI Number Information
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NPI Number | 1841005519
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Entity Type | Organization
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Legal Business Name | FHENIX WEIGHT LOSS FOREVER LLC
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Dates
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Enumeration Date | 02/10/2025
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Last Update Date | 02/10/2025
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Provider Practice Location Address
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Address Line | 13885 HEDGEWOOD DR STE 241
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City | WOODBRIDGE
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State | VA
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Zip | 22193-7931
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Country | US
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Telephone | 202-715-6626
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Fax | 765-680-8654
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Provider Business Mailing Address
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Address Line | 13885 HEDGEWOOD DR STE 241
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City | WOODBRIDGE
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State | VA
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Zip | 22193-7931
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Country | US
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Telephone | 202-715-6626
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Fax | 765-680-8654
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Authorized Official
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Title or Position | NP
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Name | TISHAMBAY THOMPSON
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Credential | FNP
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Telephone | 703-568-3876
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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