Healthcare Provider Details

I. General information

NPI: 1356267835
Provider Name (Legal Business Name): THERESA AMPONSAH BUABENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2220 EDWARD HOLLAND DR
RICHMOND VA
23230-2519
US

IV. Provider business mailing address

11306 BATH CT
FREDERICKSBURG VA
22408-5510
US

V. Phone/Fax

Practice location:
  • Phone: 804-678-7000
  • Fax:
Mailing address:
  • Phone: 571-620-9952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001347480
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: