Individual
THEOPHILINE MARY EBIASAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
10701 ROSEMARY DR, MANASSAS, VA 20109-7282
(703) 257-3000
(703) 257-3057
Mailing address
8405 MOSSY PINES WAY, GAINESVILLE, VA 20155-5209
(703) 969-4300
Taxonomy
Speciality
Code
Description
License number
State
163WL0100X
Lactation Consultant (Registered Nurse)
Primary
0001174655
VA
Other
Enumeration date
12/18/2017
Last updated
12/18/2017
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