Doctor Name: | MWEEMBA CHIPEPO |
NPI Number: | 1104225648 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 2014020747 |
Business Practice Address: | 14121 Parke Long Ct 201 Chantilly, VA - 201511647 |
Business Phone Number: | 8552471940 |
Business Fax Number: | |
Mailing Address: | 14121 Parke Long Ct, 201 CHANTILLY |
State: | VA |
Postal Code: | 201511647 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/21/2014 |
NPI Last Update Date: | 10/15/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LA2200X |
License Number: | 2014020747 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Adult Health |
Taxonomy Definition: |