MEDICARE: MS. PAMELA FONJU NP

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	363LF0000X	Family Nurse Practitioner	F335061	NY
2	363LF0000X	Family Nurse Practitioner	0024187717	VA

General Provider Information

NPI Number	:	1538367511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. PAMELA FONJU NP

Provider Business Mailing Address
First Line	:	PO BOX 748613
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30384-8613
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	10322 BRISTOW CENTER DR
Second Line	:
City	:	BRISTOW
State	:	VA
Zip	:	20136-2201
Country	:	US
Telephone Number	:	571-284-4245
Fax Number	:

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

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	08/01/2025

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