Provider Demographics
NPI:1194827139
Name:NIEKETIEN-TAWARI, CORDELIA (DNP, APRN-BC LNP)
Entity Type:Individual
Prefix:
First Name:CORDELIA
Middle Name:
Last Name:NIEKETIEN-TAWARI
Suffix:
Gender:F
Credentials:DNP, APRN-BC LNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2692
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20195-0692
Mailing Address - Country:US
Mailing Address - Phone:703-869-5361
Mailing Address - Fax:703-957-3625
Practice Address - Street 1:1850 CAMERON GLEN DR
Practice Address - Street 2:SUITE 600
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-3363
Practice Address - Country:US
Practice Address - Phone:703-481-4100
Practice Address - Fax:703-435-1961
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024165883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA190001015Medicare ID - Type UnspecifiedPROVIDER NO.
VAQ15115Medicare UPIN