Healthcare Provider Details

I. General information

NPI: 1194177527
Provider Name (Legal Business Name): N'DEEVAW ARTIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2016
Last Update Date: 07/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11484 WASHINGTON PLZ W SUITE 300
RESTON VA
20190-4344
US

IV. Provider business mailing address

25199 LARKS TER
CHANTILLY VA
20152-6682
US

V. Phone/Fax

Practice location:
  • Phone: 703-689-2180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024173709
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: