MEDICARE: PROF. NANCY JALLO RNC FNP-BC, WHNP-BCI

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	363LF0000X	Family Nurse Practitioner	0024092554	VA
2	364SP1700X	Perinatal Clinical Nurse Specialist	0015000310	VA

General Provider Information

NPI Number	:	1174930994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. NANCY JALLO RNC FNP-BC, WHNP-BCI

Provider Business Mailing Address
First Line	:	604 DAM LAKE CT
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2796
Country	:	US
Telephone Number	:	757-846-7510
Fax Number	:

Provider Business Practice Location Address
First Line	:	604 DAM LAKE CT
Second Line	:
City	:	WILLIAMSBURG
State	:	VA
Zip	:	23185-2796
Country	:	US
Telephone Number	:	757-846-7510
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2014
Last Update Date	:	07/14/2014

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