NPI 1669158895

Iddrisa Fynn

Practitioner Contractor Woodbridge, VA

Practice location

Address: 16719 Chowning CT, Woodbridge, VA 22191-4606
Phone: (170) 378-6894

Registered specialties

Contractor Primary

Other Service Providers Taxonomy 171W00000X Licence 10961131-2023 (VA)

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Registry record

NPI: 1669158895
Entity type: Individual
Sex (as registered): Male
NPI issued: 22 Jun 2023
Record last updated: 22 Jun 2023

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.