MEDICARE: IVOLINE BENAZEA NKOAMBONG

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0001344754	VA

General Provider Information

NPI Number	:	1063344430
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IVOLINE BENAZEA NKOAMBONG

Provider Business Mailing Address
First Line	:	4360 WELSH LN APT 5
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-5649
Country	:	US
Telephone Number	:	202-621-8494
Fax Number	:

Provider Business Practice Location Address
First Line	:	6323 GEORGIA AVE NW STE 360
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-1101
Country	:	US
Telephone Number	:	202-621-8494
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2026
Last Update Date	:	06/01/2026

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Directions to “ IVOLINE BENAZEA NKOAMBONG ” Practice Location

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