Healthcare Provider Details

I. General information

NPI: 1114454618
Provider Name (Legal Business Name): NICOLE CABELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2017
Last Update Date: 12/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 VARNUM ST NE
WASHINGTON DC
20017-2104
US

IV. Provider business mailing address

620 N FAYETTE ST APT 309
ALEXANDRIA VA
22314-2291
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code367H00000X
TaxonomyAnesthesiologist Assistant
License NumberAA000084
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: