Healthcare Provider Details

I. General information

NPI: 1821415472
Provider Name (Legal Business Name): MARY JAMISON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CONNECTICUT AVE NW STE 500
WASHINGTON DC
20036-5304
US

IV. Provider business mailing address

1050 CONNECTICUT AVE NW STE 500
WASHINGTON DC
20036-5304
US

V. Phone/Fax

Practice location:
  • Phone: 202-596-8891
  • Fax: 833-941-2357
Mailing address:
  • Phone: 202-596-8891
  • Fax: 833-941-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024170815
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024170815
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: