Healthcare Provider Details

I. General information

NPI: 1417326703
Provider Name (Legal Business Name): MISS EMILY RENEE CHENARI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY RENEE CHENARI AGACNPBC

II. Dates (important events)

Enumeration Date: 09/17/2015
Last Update Date: 12/07/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST PHYSICIAN'S OFFICE BUILDING NORTH SUITE 5000
WASHINGTON DC
20010
US

IV. Provider business mailing address

106 IRVING ST POB NORTH SUITE 5000
WASHINGTON DC
20010
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-6000
  • Fax: 202-877-6618
Mailing address:
  • Phone: 202-877-6000
  • Fax: 202-877-6618

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024172940
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRN0000203094
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: