Healthcare Provider Details

I. General information

NPI: 1164894093
Provider Name (Legal Business Name): JANET BABY WURIE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10520 MAIN ST
FAIRFAX VA
22030-2530
US

IV. Provider business mailing address

14315 LOUISA ST
WOODBRIDGE VA
22191-2530
US

V. Phone/Fax

Practice location:
  • Phone: 703-246-4461
  • Fax:
Mailing address:
  • Phone: 571-572-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024164913
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: