Healthcare Provider Details

I. General information

NPI: 1043132186
Provider Name (Legal Business Name): SAMIRA NICOLI HALTEH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 JAMIS PL
FREDERICKSBURG VA
22401-8443
US

IV. Provider business mailing address

1017 JAMIS PL
FREDERICKSBURG VA
22401-8443
US

V. Phone/Fax

Practice location:
  • Phone: 917-971-0715
  • Fax:
Mailing address:
  • Phone: 917-971-0715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024198220
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: