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General NPI Number Information
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NPI Number | 1831564947
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Entity Type | Individual
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Provider Name | LIDUINA N NGUNDAM NP
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Gender | Female
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Dates
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Enumeration Date | 12/01/2015
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | PENNSYLVANIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20535-0001
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | PSC 467 BOX 1318
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City | APO
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State | AE
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Zip | 09096-0014
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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 | 0024186632
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License Number State | VA
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