Provider Demographics
NPI:1407840796
Name:FORD-RINGWOOD, REBECCA HARRIET (NP)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:HARRIET
Last Name:FORD-RINGWOOD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:HARRIET
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12011 LEE JACKSON MEMORIAL HWY
Mailing Address - Street 2:SUITE 504
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22033-3310
Mailing Address - Country:US
Mailing Address - Phone:703-391-2030
Mailing Address - Fax:703-273-3943
Practice Address - Street 1:4080 LAFAYETTE CENTER DR
Practice Address - Street 2:SUITE 170
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20151-1247
Practice Address - Country:US
Practice Address - Phone:703-766-5040
Practice Address - Fax:703-766-5047
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024099224363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q28453Medicare UPIN
VA015269F32Medicare ID - Type Unspecified