Healthcare Provider Details

I. General information

NPI: 1598615882
Provider Name (Legal Business Name): HADDIJATOU JARJUSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23710 SCHOOLER PLZ STE 275
ASHBURN VA
20148-1944
US

IV. Provider business mailing address

23710 SCHOOLER PLZ STE 275
ASHBURN VA
20148-1944
US

V. Phone/Fax

Practice location:
  • Phone: 571-717-6089
  • Fax:
Mailing address:
  • Phone: 571-717-6089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number000-209-0432
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: