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1417350018
ELLEN IDUMA
FAIRFAX, VA
NPI
1417350018
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Former Name
ELLEN JOHN
Entity Type
Individual
Gender
Female
Sole Proprietor ?
No
Primary Taxonomy
363LF0000X Nurse Practitioner, Family
(Licence: VA 0024171998)
Enumeration Date
2014-09-27
Last Update Date
2020-01-03
Business Address
ELLEN IDUMA
10301 NEW GUINEA RD
FAIRFAX, VA 22032-3268
Phone number: 703-764-5112
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Mailing Address
ELLEN IDUMA
9420 PARK HUNT CT
SPRINGFIELD, VA 22153-1351
Phone number: 703-909-4975
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