Healthcare Provider Details

I. General information

NPI: 1891922944
Provider Name (Legal Business Name): MARIAM USMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2009
Last Update Date: 06/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9409B OLD BURKE LAKE RD
BURKE VA
22015-3127
US

IV. Provider business mailing address

9409B OLD BURKE LAKE RD
BURKE VA
22015-3127
US

V. Phone/Fax

Practice location:
  • Phone: 703-978-4200
  • Fax:
Mailing address:
  • Phone: 703-978-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024168334
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: