Healthcare Provider Details

I. General information

NPI: 1679243950
Provider Name (Legal Business Name): JAN MARCUS DAJERO QUIAOIT NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/17/2021
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5255 LOUGHBORO RD NW
WASHINGTON DC
20016-2633
US

IV. Provider business mailing address

5597 SEMINARY RD APT 112
FALLS CHURCH VA
22041-2684
US

V. Phone/Fax

Practice location:
  • Phone: 202-537-4556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN1037841
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024182840
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberNP1037841
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: