Healthcare Provider Details

I. General information

NPI: 1134881758
Provider Name (Legal Business Name): MARIATU KASIM TURAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6225 BRANDON AVE STE 365
SPRINGFIELD VA
22150-2526
US

IV. Provider business mailing address

PO BOX 639295
CINCINNATI OH
45263-9295
US

V. Phone/Fax

Practice location:
  • Phone: 571-642-3433
  • Fax: 855-998-8571
Mailing address:
  • Phone: 571-642-3433
  • Fax: 855-998-8571

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number0024182732
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: