Healthcare Provider Details

I. General information

NPI: 1487366738
Provider Name (Legal Business Name): NZIGIRE MATALI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2022
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5502 CALLANDER DR
SPRINGFIELD VA
22151-1402
US

IV. Provider business mailing address

5502 CALLANDER DR
SPRINGFIELD VA
22151-1402
US

V. Phone/Fax

Practice location:
  • Phone: 703-336-1363
  • Fax:
Mailing address:
  • Phone: 703-336-1363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024186017
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: