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General NPI Number Information
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NPI Number | 1043088214
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Entity Type | Organization
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Legal Business Name | STAT PROFESSIONAL SERVICES, LLC
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Dates
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Enumeration Date | 12/18/2023
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Last Update Date | 12/18/2023
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Provider Practice Location Address
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Address Line | 14005 CROSSING PL STE 202
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City | WOODBRIDGE
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State | VA
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Zip | 22192-4686
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Country | US
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Telephone | 703-997-0967
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Fax | 703-997-0073
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Provider Business Mailing Address
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Address Line | 15000 POTOMAC TOWN PL STE 100-150
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City | WOODBRIDGE
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State | VA
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Zip | 22191-6586
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Country | US
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Telephone | 703-997-0967
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Fax | 703-997-0073
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Authorized Official
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Title or Position | OWNER
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Name | NNENNA ONWUNMELU
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Credential | RN
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Telephone | 773-997-0037
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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