Healthcare Provider Details

I. General information

NPI: 1598359549
Provider Name (Legal Business Name): HAWANATU S JALLOH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2021
Last Update Date: 02/21/2021
Certification Date: 02/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14155 CASTLE BLVD
SILVER SPRING MD
20904-4751
US

IV. Provider business mailing address

14155 CASTLE BLVD
SILVER SPRING MD
20904-4751
US

V. Phone/Fax

Practice location:
  • Phone: 240-277-2121
  • Fax: 410-946-2010
Mailing address:
  • Phone: 240-277-2121
  • Fax: 410-946-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLP39618
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: