Healthcare Provider Details

I. General information

NPI: 1528614245
Provider Name (Legal Business Name): MARY WARRAH TARAWALIE APRN- PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALUSINE KAIKAI

II. Dates (important events)

Enumeration Date: 08/18/2019
Last Update Date: 02/13/2025
Certification Date: 02/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19703 EXECUTIVE PARK CIR
GERMANTOWN MD
20874-2639
US

IV. Provider business mailing address

700 12TH ST NW STE 700
WASHINGTON DC
20005-4052
US

V. Phone/Fax

Practice location:
  • Phone: 301-946-6623
  • Fax: 301-946-1107
Mailing address:
  • Phone: 415-735-5804
  • Fax: 855-249-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP1028109
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR202403
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024183031
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1028109
License Number StateDC
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024183031
License Number StateVA
# 6
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR202403
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: