Provider Demographics
NPI:1932836764
Name:FAN, RONG (FNP)
Entity type:Individual
Prefix:
First Name:RONG
Middle Name:
Last Name:FAN
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 1:1680 CAPITAL ONE DR # C2
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22102-3407
Mailing Address - Country:US
Mailing Address - Phone:703-720-1290
Mailing Address - Fax:703-720-1291
Practice Address - Street 1:1680 CAPITAL ONE DR # C2
Practice Address - Street 2:
Practice Address - City:MC LEAN
Practice Address - State:VA
Practice Address - Zip Code:22102-3407
Practice Address - Country:US
Practice Address - Phone:703-720-1290
Practice Address - Fax:703-720-1291
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001285315163W00000X
VA0024184817363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse