Healthcare Provider Details

I. General information

NPI: 1104150598
Provider Name (Legal Business Name): ZITA BRIGITTA BUKY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2009
Last Update Date: 01/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9010 LORTON STATION BLVD STE 220
LORTON VA
22079-4792
US

IV. Provider business mailing address

9010 LORTON STATION BLVD STE 220
LORTON VA
22079-4792
US

V. Phone/Fax

Practice location:
  • Phone: 703-220-6006
  • Fax: 703-646-5262
Mailing address:
  • Phone: 703-220-6006
  • Fax: 703-646-5262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024164051
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: