Provider Demographics
NPI:1134668155
Name:GEBRESELLASIE, TSION (FNP)
Entity Type:Individual
Prefix:
First Name:TSION
Middle Name:
Last Name:GEBRESELLASIE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7839A ROLLING RD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-2821
Mailing Address - Country:US
Mailing Address - Phone:703-569-6998
Mailing Address - Fax:703-569-7008
Practice Address - Street 1:7839A ROLLING RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22153-2821
Practice Address - Country:US
Practice Address - Phone:703-569-6998
Practice Address - Fax:703-569-7008
Is Sole Proprietor?:No
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174331363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA079626Medicare PIN