Provider Demographics
NPI:1508144189
Name:TEWOLDE, SENAIT (ANP-BC)
Entity Type:Individual
Prefix:
First Name:SENAIT
Middle Name:
Last Name:TEWOLDE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8322 BARK TREE CT
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22153-3828
Mailing Address - Country:US
Mailing Address - Phone:202-877-0275
Mailing Address - Fax:202-800-2845
Practice Address - Street 1:8505 ARLINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-4630
Practice Address - Country:US
Practice Address - Phone:703-698-8525
Practice Address - Fax:703-698-8527
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1003185363LA2200X
VA0024171191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health