Provider Demographics
NPI:1811416423
Name:AKWETEY, ANITA DEDEI
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:DEDEI
Last Name:AKWETEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7754B MILFORD HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-4737
Mailing Address - Country:US
Mailing Address - Phone:571-276-5132
Mailing Address - Fax:
Practice Address - Street 1:14904 JEFFERSON DAVIS HWY STE 305
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-3908
Practice Address - Country:US
Practice Address - Phone:571-492-7702
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-14
Last Update Date:2017-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024175364OtherVIRGINIA BOARD OF NURSING