Healthcare Provider Details

I. General information

NPI: 1184241614
Provider Name (Legal Business Name): YULIYA MATSOVA HAMPE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10605 CONCORD ST
KENSINGTON MD
20895-2504
US

IV. Provider business mailing address

4308 SUTLER HILL SQ
FAIRFAX VA
22033-4256
US

V. Phone/Fax

Practice location:
  • Phone: 301-942-9833
  • Fax:
Mailing address:
  • Phone: 440-596-9804
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAC003234
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024179619
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024179619
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024179619
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number0024179619
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: