MEDICARE: CATHERINE NKEIRUKA BEN-AGU

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	AC003547	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024180109	VA

General Provider Information

NPI Number	:	1801402508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE NKEIRUKA BEN-AGU

Provider Business Mailing Address
First Line	:	5656 LIBERTY MANOR CIR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-3279
Country	:	US
Telephone Number	:	571-505-1775
Fax Number	:

Provider Business Practice Location Address
First Line	:	5656 LIBERTY MANOR CIR
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-3279
Country	:	US
Telephone Number	:	571-505-1775
Fax Number	:

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

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	02/12/2026

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