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General NPI Number Information
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NPI Number | 1174320360
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Entity Type | Individual
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Provider Name | DADDY BRIAN NGWA AFANWI
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Gender | Male
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Dates
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Enumeration Date | 02/26/2025
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Last Update Date | 02/26/2025
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Provider Practice Location Address
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Address Line | 4565 DAISY REID AVE
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5670
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Country | US
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Telephone | 571-602-1888
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Fax |
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Provider Business Mailing Address
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Address Line | 15378 BALD EAGLE LN
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3739
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Country | US
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Telephone | 571-602-1888
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number |
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License Number State |
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