1194430116 NPI number — ZORODZAI GUTU FNP

Table of content: ZORODZAI GUTU FNP (NPI 1194430116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194430116 NPI number — ZORODZAI GUTU FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GUTU
Provider First Name:
ZORODZAI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194430116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
43426 ROBEY SQ
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ASHBURN
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
20148-6785
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-449-1922
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 N MAPLE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PURCELLVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
20132-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-338-0032
Provider Business Practice Location Address Fax Number:
540-338-0176
Provider Enumeration Date:
01/16/2023

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  0024185751 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30017568300001 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1194430116 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".