Healthcare Provider Details

I. General information

NPI: 1285121954
Provider Name (Legal Business Name): FATMATA K WARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2018
Last Update Date: 12/15/2020
Certification Date: 12/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 VARNUM ST NE
WASHINGTON DC
20017-2107
US

IV. Provider business mailing address

1160 VARNUM ST NE
WASHINGTON DC
20017-2107
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1006839
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: