Healthcare Provider Details

I. General information

NPI: 1710172895
Provider Name (Legal Business Name): JYOTIKA DEVI VAZIRANI CRNP CS P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 09/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 U STREET NW SUITE 1
WASHINGTON DC
20009
US

IV. Provider business mailing address

1632 OAKLAWN CT
SILVER SPRING MD
20903-1415
US

V. Phone/Fax

Practice location:
  • Phone: 301-404-8196
  • Fax: 301-593-1033
Mailing address:
  • Phone: 301-404-8196
  • Fax: 301-593-1033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR130047
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN64943
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR130047
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: