MEDICARE: FIRST STEP FAMILY CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	363L00000X	Nurse Practitioner	0024165857	VA

General Provider Information

NPI Number	:	1023325735
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST STEP FAMILY CARE, LLC

Provider Business Mailing Address
First Line	:	3303 DUKE STREET
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4522
Country	:	US
Telephone Number	:	703-212-6644
Fax Number	:	703-212-6619

Provider Business Practice Location Address
First Line	:	3303 DUKE STREET
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-4522
Country	:	US
Telephone Number	:	703-212-6644
Fax Number	:	703-212-6619

Authorized Official
Title or Position	:	RN MSN BC-FNP
Name	:	MS. MARIATU K. KARGBO
Credential	:	RN MSN BC-FNP
Telephone Number	:	703-212-6644

Provider Enumeration Date	:	09/02/2010
Last Update Date	:	05/04/2011

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