Provider Demographics
NPI:1932747359
Name:TESFAHUN, MARTHA (FNP)
Entity type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:TESFAHUN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OWENS GLEN CT
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2300
Mailing Address - Country:US
Mailing Address - Phone:301-503-3718
Mailing Address - Fax:
Practice Address - Street 1:4600 LANGSTON BLVD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22207
Practice Address - Country:US
Practice Address - Phone:571-492-3080
Practice Address - Fax:571-492-3081
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024178440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily