Healthcare Provider Details

I. General information

NPI: 1912832783
Provider Name (Legal Business Name): EFUA DUMA PANYIN CRENTSIL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15200 LEICESTERSHIRE ST UNIT I-155
WOODBRIDGE VA
22191-5919
US

IV. Provider business mailing address

15200 LEICESTERSHIRE ST UNIT I-155
WOODBRIDGE VA
22191-5919
US

V. Phone/Fax

Practice location:
  • Phone: 734-834-0460
  • Fax:
Mailing address:
  • Phone: 734-834-0460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024195404
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: