Healthcare Provider Details

I. General information

NPI: 1780381194
Provider Name (Legal Business Name): MARIAH EZE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2023
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12751 MARBLESTONE DR STE 240
WOODBRIDGE VA
22192-8336
US

IV. Provider business mailing address

12751 MARBLESTONE DR STE 240
WOODBRIDGE VA
22192-8336
US

V. Phone/Fax

Practice location:
  • Phone: 703-650-9202
  • Fax: 703-650-9414
Mailing address:
  • Phone: 703-650-9202
  • Fax: 703-650-9414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1048325
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95039909
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024186469
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP61671865
License Number StateWA
# 5
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberTPAN4318
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11048637
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberN33272
License Number StateNY
# 8
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAC005103
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: