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General NPI Number Information
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NPI Number | 1710080205
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Entity Type | Individual
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Provider Name | GIBSON IYEKE ERHUNMWUNSE NP
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Gender | Male
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Dates
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Enumeration Date | 09/07/2006
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 550 S CARLIN SPRINGS RD
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City | ARLINGTON
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State | VA
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Zip | 22204
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Country | US
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Telephone | 703-379-7200
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Fax | 703-578-5524
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Provider Business Mailing Address
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Address Line | 2812 CORNFLOWER LN
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City | WALDORF
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State | MD
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Zip | 20603
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Country | US
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Telephone | 301-885-1587
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0017138050
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License Number State | VA
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