Healthcare Provider Details

I. General information

NPI: 1548538333
Provider Name (Legal Business Name): JO ELLEN DOCKSTADER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 E ST NW
WASHINGTON DC
20522-0001
US

IV. Provider business mailing address

2401 E ST NW
WASHINGTON DC
20522-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-235-7475
  • Fax: 202-261-8651
Mailing address:
  • Phone: 202-235-7475
  • Fax: 202-261-8651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberNP500018383
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: