Healthcare Provider Details

I. General information

NPI: 1114498797
Provider Name (Legal Business Name): NOUR EL HOUDA AMRI CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2018
Last Update Date: 12/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6829 ELM ST STE 300
MC LEAN VA
22101-3845
US

IV. Provider business mailing address

5303 POOKS HILL RD
BETHESDA MD
20814-2004
US

V. Phone/Fax

Practice location:
  • Phone: 703-532-4892
  • Fax:
Mailing address:
  • Phone: 301-272-5084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: