Healthcare Provider Details

I. General information

NPI: 1164148813
Provider Name (Legal Business Name): FATMATA MOHAMMED JABBIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2022
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 HUNTER PL STE 101
WOODBRIDGE VA
22192-3938
US

IV. Provider business mailing address

2510 HUNTER PL STE 101
WOODBRIDGE VA
22192-3938
US

V. Phone/Fax

Practice location:
  • Phone: 571-316-1069
  • Fax: 571-402-7907
Mailing address:
  • Phone: 571-316-1069
  • Fax: 571-402-7907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001307757
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: