Healthcare Provider Details

I. General information

NPI: 1114537545
Provider Name (Legal Business Name): PAMELA NGEGHUA WANKI FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2020
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208D W BROAD ST
FALLS CHURCH VA
22046-2116
US

IV. Provider business mailing address

PO BOX 791775
BALTIMORE MD
21279-1775
US

V. Phone/Fax

Practice location:
  • Phone: 571-766-8927
  • Fax: 571-766-8928
Mailing address:
  • Phone: 571-302-5000
  • Fax: 571-302-5001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024185615
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: