Individual
MRS. AMAZING-GRACE IGHEDO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
RESTON HOSPITAL CENTER, 607 HERNDON PARKWAY SUITE 101, RESTON, VA 20171
(703) 471-0919
Mailing address
23632 SAILFISH SQ, BRAMBLETON, VA 20148-7633
(515) 305-6365
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001309826
VA
367500000X
Certified Registered Nurse Anesthetist
Primary
0024190753
VA
Other
Enumeration date
06/25/2024
Last updated
07/18/2024
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