Healthcare Provider Details

I. General information

NPI: 1215741301
Provider Name (Legal Business Name): IVY DZIFA DZIVENU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2025
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

712 H ST NE STE 1379
WASHINGTON DC
20002-3627
US

IV. Provider business mailing address

712 H ST NE STE 1379
WASHINGTON DC
20002-3627
US

V. Phone/Fax

Practice location:
  • Phone: 571-275-5935
  • Fax:
Mailing address:
  • Phone: 571-275-5935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024192399
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP500125648
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: