Individual
ETHNA YAMBASU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14320 WESTWAY LN, WOODBRIDGE, VA 22193-2800
(703) 939-2077
Mailing address
14320 WESTWAY LN, WOODBRIDGE, VA 22193-2800
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
0002089920
VA
Other
Enumeration date
09/30/2016
Last updated
09/30/2016
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