Individual
FUNMILAYO BETHANY JEFFERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1954 OPITZ BLVD, WOODBRIDGE, VA 22191-3304
(703) 492-2924
Mailing address
13520 MCLEAREN RD UNIT 711112, HERNDON, VA 20171-8046
(855) 933-2388
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
0001312747
VA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
0024187026
VA
Other
Enumeration date
04/10/2023
Last updated
05/03/2023
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