Provider Demographics
NPI:1083228217
Name:MUKHAMEDOVA, IRODA T (MSN, RN, FNP-C)
Entity Type:Individual
Prefix:
First Name:IRODA
Middle Name:T
Last Name:MUKHAMEDOVA
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2661 ST ELIAS DR UNIT A
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-3535
Mailing Address - Country:US
Mailing Address - Phone:901-428-6389
Mailing Address - Fax:
Practice Address - Street 1:14101 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-6523
Practice Address - Country:US
Practice Address - Phone:804-893-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-04
Last Update Date:2023-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily