MEDICARE: SHANNON JIHYE HWANG FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0001242479	VA
2	363LF0000X	Family Nurse Practitioner	0024178530	VA

General Provider Information

NPI Number	:	1659913143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON JIHYE HWANG FNP-BC

Provider Business Mailing Address
First Line	:	6715 LITTLE RIVER TPKE STE 201
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3546
Country	:	US
Telephone Number	:	703-535-5568
Fax Number	:	703-299-1794

Provider Business Practice Location Address
First Line	:	6715 LITTLE RIVER TPKE STE 201
Second Line	:
City	:	ANNANDALE
State	:	VA
Zip	:	22003-3546
Country	:	US
Telephone Number	:	703-535-5568
Fax Number	:	703-299-1794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/16/2019
Last Update Date	:	03/04/2026

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