Healthcare Provider Details

I. General information

NPI: 1427787902
Provider Name (Legal Business Name): NARDOS MITIKU ZELEKE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2022
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2296 OPITZ BLVD STE 130
WOODBRIDGE VA
22191-3344
US

IV. Provider business mailing address

176 SHADED VALLEY CT
STAFFORD VA
22554-7786
US

V. Phone/Fax

Practice location:
  • Phone: 703-523-0660
  • Fax: 571-542-9965
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024184243
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024184243
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: