MEDICARE: MESERET TADESSE BULCHA

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	0001227599	VA
2	363LF0000X	Family Nurse Practitioner	0024185752	VA

General Provider Information

NPI Number	:	1861118473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MESERET TADESSE BULCHA

Provider Business Mailing Address
First Line	:	1636 BELLE VIEW BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6531
Country	:	US
Telephone Number	:	703-768-7044
Fax Number	:

Provider Business Practice Location Address
First Line	:	1636 BELLE VIEW BLVD
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22307-6531
Country	:	US
Telephone Number	:	703-768-7044
Fax Number	:

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

Provider Enumeration Date	:	10/14/2022
Last Update Date	:	04/08/2026

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