Provider Demographics
NPI:1164961538
Name:ANWOMEA, KWASI (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:KWASI
Middle Name:
Last Name:ANWOMEA
Suffix:
Gender:M
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8705 STONEWALL RD
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20110-4534
Mailing Address - Country:US
Mailing Address - Phone:703-659-9640
Mailing Address - Fax:703-659-9616
Practice Address - Street 1:8705 STONEWALL RD
Practice Address - Street 2:
Practice Address - City:MANASSAS
Practice Address - State:VA
Practice Address - Zip Code:20110-4534
Practice Address - Country:US
Practice Address - Phone:703-659-9640
Practice Address - Fax:703-659-9616
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-18
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174489314000000X, 363L00000X, 363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care