Individual
ODONTUYA PUREVSANGA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
2 PIDGEON HILL DRIVE, SUITE 400, STERLING, VA 20165-6129
(703) 430-7090
(703) 444-9878
Mailing address
1050 N TAYLOR ST APT 408, ARLINGTON, VA 22201-4774
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
0024175395
VA
363LA2200X
Adult Health Nurse Practitioner
201500384NP-PP
OR
363LA2200X
Adult Health Nurse Practitioner
4704288222
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1811392103
—
VA
Enumeration date
10/29/2014
Last updated
01/10/2024
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