Healthcare Provider Details

I. General information

NPI: 1073460754
Provider Name (Legal Business Name): SIA EBITOMI M BOATENG DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8006 DISCOVERY DR STE 400
HENRICO VA
23229-8600
US

IV. Provider business mailing address

7300 ASHLAKE PKWY STE 200
CHESTERFIELD VA
23832-2827
US

V. Phone/Fax

Practice location:
  • Phone: 804-256-8282
  • Fax:
Mailing address:
  • Phone: 804-256-8282
  • Fax: 804-256-8288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024197759
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: