Provider Demographics
NPI:1043820319
Name:SARPONG, ANNETTE (RN)
Entity type:Individual
Prefix:MS
First Name:ANNETTE
Middle Name:
Last Name:SARPONG
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15337 BARNABAS TRL
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5566
Mailing Address - Country:US
Mailing Address - Phone:571-201-6803
Mailing Address - Fax:703-986-0717
Practice Address - Street 1:15337 BARNABAS TRL
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5566
Practice Address - Country:US
Practice Address - Phone:571-201-6803
Practice Address - Fax:703-986-0717
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001239650163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health