Healthcare Provider Details

I. General information

NPI: 1639006034
Provider Name (Legal Business Name): EUNICE N KPADUWA PMHNP- BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2026
Last Update Date: 05/07/2026
Certification Date: 05/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46179 WESTLAKE DR STE 220
STERLING VA
20165-5874
US

IV. Provider business mailing address

42699 WARDLAW TER
ASHBURN VA
20147-3581
US

V. Phone/Fax

Practice location:
  • Phone: 703-994-7406
  • Fax:
Mailing address:
  • Phone: 703-994-7406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024197350
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: