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General NPI Number Information
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NPI Number | 1598537755
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Entity Type | Individual
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Provider Name | SANDRINE LAURE DEIGHELA MAPOKAM FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/23/2023
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 5140 RIVER CLUB DR STE 102
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City | SUFFOLK
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State | VA
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Zip | 23435-3799
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Country | US
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Telephone | 757-977-1110
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Fax |
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Provider Business Mailing Address
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Address Line | 5111 MORELAND ST
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City | SUFFOLK
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State | VA
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Zip | 23435-3438
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Country | US
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Telephone | 240-706-2941
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024187652
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License Number State | VA
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