Healthcare Provider Details

I. General information

NPI: 1285725507
Provider Name (Legal Business Name): ELLEN DIROMA APATOV APRNBC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6900 GEORGIA AVE WALTER REED ARMY MEDICAL CENTER
WASHINGTON DC
20307
US

IV. Provider business mailing address

7111 EDGEVALE ST
CHEVY CHASE MD
20815-5907
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-5955
  • Fax:
Mailing address:
  • Phone: 301-986-1088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRI129632
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: