Provider Demographics
NPI:1912380155
Name:KHORSHIDI, HANIEH (BSN, AGNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:HANIEH
Middle Name:
Last Name:KHORSHIDI
Suffix:
Gender:F
Credentials:BSN, AGNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312 WALKER RD
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:VA
Mailing Address - Zip Code:22066-3507
Mailing Address - Country:US
Mailing Address - Phone:703-400-3866
Mailing Address - Fax:703-671-2476
Practice Address - Street 1:10220 RIVER RD STE 4
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-4907
Practice Address - Country:US
Practice Address - Phone:703-400-3866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172715363LG0600X, 363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care