Healthcare Provider Details

I. General information

NPI: 1801062229
Provider Name (Legal Business Name): CHIZIMAKO MARGARET EZE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9720 CAPITAL CT STE 404
MANASSAS VA
20110-2052
US

IV. Provider business mailing address

9720 CAPITAL CT STE 404
MANASSAS VA
20110-2052
US

V. Phone/Fax

Practice location:
  • Phone: 703-843-0665
  • Fax: 703-544-4686
Mailing address:
  • Phone: 703-843-0665
  • Fax: 703-544-4686

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172597
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001201522
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: