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General NPI Number Information
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NPI Number | 1629702568
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Entity Type | Individual
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Provider Name | DONNA BAMBACH
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Gender | Female
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Dates
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Enumeration Date | 07/15/2022
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 5226 DAWES AVE
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City | ALEXANDRIA
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State | VA
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Zip | 22311-1404
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Country | US
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Telephone | 703-212-9190
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Fax |
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Provider Business Mailing Address
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Address Line | 79 POTOMAC AVE SE APT 410
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City | WASHINGTON
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State | DC
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Zip | 20003-3683
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | F07220953
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License Number State | VA
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