Individual
MRS. SHANNON AIFUWA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
11331 W BROAD ST, 129, GLEN ALLEN, VA 23060-5805
(804) 364-0521
Mailing address
11331 W BROAD ST, 129, GLEN ALLEN, VA 23060-5805
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0024171617
VA
363LG0600X
Gerontology Nurse Practitioner
0024171617
VA
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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