Provider Demographics
NPI:1669931069
Name:ILODIANYA, IFEOMA ELIZABETH (NP)
Entity type:Individual
Prefix:
First Name:IFEOMA
Middle Name:ELIZABETH
Last Name:ILODIANYA
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 1:43662 JERNIGAN TER
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1279
Mailing Address - Country:US
Mailing Address - Phone:678-431-9980
Mailing Address - Fax:
Practice Address - Street 1:46090 LAKE CENTER PLZ
Practice Address - Street 2:
Practice Address - City:POTOMAC FALLS
Practice Address - State:VA
Practice Address - Zip Code:20165-5876
Practice Address - Country:US
Practice Address - Phone:678-431-9980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-15
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177370363LF0000X
MDAC003135363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily