Healthcare Provider Details

I. General information

NPI: 1861171845
Provider Name (Legal Business Name): STAT PROFESSIONAL SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2023
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2542 PRINCE WILLIAM PKWY UNIT 120, SUITE 25
WOODBRIDGE VA
22192
US

IV. Provider business mailing address

15000 POTOMAC TOWN PL STE 100-150
WOODBRIDGE VA
22191-6586
US

V. Phone/Fax

Practice location:
  • Phone: 703-997-0967
  • Fax: 703-997-0073
Mailing address:
  • Phone: 703-997-0967
  • Fax: 703-997-0073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number
License Number StateNULL

VIII. Authorized Official

Name: NNENNA ONWUNMELU
Title or Position: OWNER
Credential: RN
Phone: 703-997-0967