MEDICARE: NOVA DIABETES PREVENTION & MANAGEMENT, INC.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251J00000X	Nursing Care Agency
3	251K00000X	Public Health or Welfare Agency
4	163W00000X	Registered Nurse

General Provider Information

NPI Number	:	1982420493
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOVA DIABETES PREVENTION & MANAGEMENT, INC.

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	:	703-586-3751
Fax Number	:

Authorized Official
Title or Position	:	LIFESTYLE COACH/DSMES
Name	:	CHARITY C NWANEVU
Credential	:	RN-MPH
Telephone Number	:	703-586-2751

Provider Enumeration Date	:	11/30/2024
Last Update Date	:	05/17/2025

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