Individual
ELLEN IDUMA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10301 NEW GUINEA RD, FAIRFAX, VA 22032-3268
(703) 764-5112
Mailing address
9420 PARK HUNT CT, SPRINGFIELD, VA 22153-1351
(703) 909-4975
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
0024171998
VA
Other
Enumeration date
09/27/2014
Last updated
01/03/2020
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