Provider Demographics
NPI:1588219778
Name:NYINDEM, LAURA KANGHA (FNP)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:KANGHA
Last Name:NYINDEM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5966 SPOUT SPRING CT
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3307
Mailing Address - Country:US
Mailing Address - Phone:703-772-7040
Mailing Address - Fax:
Practice Address - Street 1:24801 PINEBROOK RD STE 110
Practice Address - Street 2:
Practice Address - City:CHANTILLY
Practice Address - State:VA
Practice Address - Zip Code:20152-4113
Practice Address - Country:US
Practice Address - Phone:703-722-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2019045593363LF0000X
VA0024178273363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily