Individual
SAMONE IGHOFOSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-C
Contact information
Practice address
4400 UNIVERSITY DR, FAIRFAX, VA 22030-4422
(270) 307-1479
Mailing address
1040 HUFF RD NW APT 1204, ATLANTA, GA 30318-4141
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
233305
GA
363LP2300X
Primary Care Nurse Practitioner
Primary
0024176758
VA
Other
Enumeration date
01/16/2019
Last updated
10/08/2021
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