Provider Demographics
NPI:1932672763
Name:ALAEDU, NNEBUISI
Entity Type:Individual
Prefix:
First Name:NNEBUISI
Middle Name:
Last Name:ALAEDU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24427 MUSSELLWHITE DR
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:VA
Mailing Address - Zip Code:23891-2222
Mailing Address - Country:US
Mailing Address - Phone:804-834-2678
Mailing Address - Fax:
Practice Address - Street 1:24427 MUSSELLWHITE DR
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:VA
Practice Address - Zip Code:23891-2222
Practice Address - Country:US
Practice Address - Phone:804-834-2678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2019-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175268363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily