MEDICARE: CHARITY NWANEVU

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	0001198203	VA
2	2083P0901X	Public Health & General Preventive Medicine Physician	0001198203	VA
3	171400000X	Health & Wellness Coach

General Provider Information

NPI Number	:	1487446415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARITY NWANEVU

Provider Business Mailing Address
First Line	:	12311 BEECHNUT CT
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2002
Country	:	US
Telephone Number	:	703-586-2751
Fax Number	:

Provider Business Practice Location Address
First Line	:	12311 BEECHNUT CT
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22192-2002
Country	:	US
Telephone Number	:	703-586-2751
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2025
Last Update Date	:	05/17/2025

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Directions to “ CHARITY NWANEVU ” Practice Location

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