Healthcare Provider Details

I. General information

NPI: 1952842536
Provider Name (Legal Business Name): ERIKA JAMBAL ELLIS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2017
Last Update Date: 05/20/2022
Certification Date: 05/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 17TH ST NW
WASHINGTON DC
20009-2453
US

IV. Provider business mailing address

17336 PICKWICK DR
PURCELLVILLE VA
20132-6179
US

V. Phone/Fax

Practice location:
  • Phone: 202-483-4400
  • Fax: 540-338-1975
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174622
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN1040936
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: