Doctor Name: | ENYONAM JORDAN-BRANGMAN |
NPI Number: | 1114112604 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | RN |
License Number: | 0001191728 |
Business Practice Address: | 4213 Walney Rd Chantilly, VA - 201512923 |
Business Phone Number: | 7035027000 |
Business Fax Number: | |
Mailing Address: | 13827 Laura Ratcliff Ct, CENTREVILLE |
State: | VA |
Postal Code: | 201213515 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 09/08/2007 |
NPI Last Update Date: | 09/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 163WA0400X |
License Number: | 0001191728 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Nursing Service Providers |
Taxonomy Classification: | Registered Nurse |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |