Healthcare Provider Details

I. General information

NPI: 1326562414
Provider Name (Legal Business Name): ALFIYA GUSHA HASU FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2041 GEORGIA AVE NE
WASHINGTON DC
20059-0001
US

IV. Provider business mailing address

2041 GEORGIA AVE NW
WASHINGTON DC
20059-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-865-6100
  • Fax:
Mailing address:
  • Phone: 202-865-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1017076
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: