Healthcare Provider Details

I. General information

NPI: 1558284893
Provider Name (Legal Business Name): TRUE FORM WELLNESS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 MARYLAND DR. SUITE S
RICHMOND VA
23294
US

IV. Provider business mailing address

8401 MARYLAND DR. SUITE S
RICHMOND VA
23294
US

V. Phone/Fax

Practice location:
  • Phone: 571-332-8757
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AILEEN OSEI-KUFUOR
Title or Position: NURSE PRACTITIONER
Credential: FNP-BC
Phone: 571-332-8757