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General NPI Number Information
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NPI Number | 1427787902
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Entity Type | Individual
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Provider Name | NARDOS MITIKU ZELEKE FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/09/2022
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 2296 OPITZ BLVD STE 130
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City | WOODBRIDGE
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State | VA
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Zip | 22191-3344
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Country | US
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Telephone | 703-523-0660
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Fax | 571-542-9965
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Provider Business Mailing Address
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Address Line | 176 SHADED VALLEY CT
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City | STAFFORD
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State | VA
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Zip | 22554-7786
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Country | US
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Telephone |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 0024184243
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024184243
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License Number State | VA
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