Healthcare Provider Details

I. General information

NPI: 1578108056
Provider Name (Legal Business Name): STEFANIE A PHILISTIN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEFANIE ABOAGYE NP

II. Dates (important events)

Enumeration Date: 11/08/2019
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 RESERVOIR RD NW
WASHINGTON DC
20007-2113
US

IV. Provider business mailing address

4124 APPLEGATE CT
SUITLAND MD
20746-3056
US

V. Phone/Fax

Practice location:
  • Phone: 202-444-3320
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1036103
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: