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General NPI Number Information
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NPI Number | 1619694361
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Entity Type | Individual
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Provider Name | CECILIA NTOBO FAISON NGWA
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Gender | Female
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Dates
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Enumeration Date | 10/24/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 5801 BREMO RD
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City | RICHMOND
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State | VA
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Zip | 23226-1907
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Country | US
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Telephone | 804-281-8298
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Fax |
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Provider Business Mailing Address
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Address Line | 7338 LEGACY LN
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City | RUTHER GLEN
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State | VA
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Zip | 22546-2954
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Country | US
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Telephone | 757-535-9609
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2022064027
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License Number State | VA
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