Provider Demographics
NPI:1891170833
Name:LEDWITH, MECHELLE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MECHELLE
Middle Name:
Last Name:LEDWITH
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6230 ROLLING RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-2307
Mailing Address - Country:US
Mailing Address - Phone:571-665-6460
Mailing Address - Fax:
Practice Address - Street 1:6230 ROLLING RD
Practice Address - Street 2:SUITE J
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-2307
Practice Address - Country:US
Practice Address - Phone:571-665-6460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172758363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily