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NPI Code Detail

MEDICARE: MRS. FAFA ISABEL NYIRENDA

MEDICARE: MRS. FAFA ISABEL NYIRENDA
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
1208000000XPediatrics Physician0101252178VA

General Provider Information

NPI Number : 1255565750
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. FAFA ISABEL NYIRENDA
Provider Business Mailing Address
First Line : 2035 WATERSIDE RD
Second Line : SUITE 105
City : PRINCE GEORGE
State : VA
Zip : 23875-1265
Country : US
Telephone Number : 901-491-3101
Fax Number :
Provider Business Practice Location Address
First Line : 2035 WATERSIDE RD
Second Line : SUITE 105
City : PRINCE GEORGE
State : VA
Zip : 23875-1265
Country : US
Telephone Number : 901-491-3101
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/12/2009
Last Update Date : 10/01/2012

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Directions to “ MRS. FAFA ISABEL NYIRENDA ” Practice Location

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