Provider Demographics
NPI:1114473741
Name:ESUNGE, EUNICE N (NP)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:N
Last Name:ESUNGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 GARRISONVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-1573
Mailing Address - Country:US
Mailing Address - Phone:540-657-9441
Mailing Address - Fax:540-657-4366
Practice Address - Street 1:422 GARRISONVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-1573
Practice Address - Country:US
Practice Address - Phone:540-657-9441
Practice Address - Fax:540-657-4366
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024173793363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily