MEDICARE: EUNICE N KPADUWA PMHNP- BC

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024197350	VA

General Provider Information

NPI Number	:	1639006034
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUNICE N KPADUWA PMHNP- BC

Provider Business Mailing Address
First Line	:	42699 WARDLAW TER
Second Line	:
City	:	ASHBURN
State	:	VA
Zip	:	20147-3581
Country	:	US
Telephone Number	:	703-994-7406
Fax Number	:

Provider Business Practice Location Address
First Line	:	46179 WESTLAKE DR STE 220
Second Line	:
City	:	STERLING
State	:	VA
Zip	:	20165-5874
Country	:	US
Telephone Number	:	703-994-7406
Fax Number	:

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

Provider Enumeration Date	:	05/07/2026
Last Update Date	:	05/07/2026

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