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General NPI Number Information
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NPI Number | 1174930994
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Entity Type | Individual
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Provider Name | NANCY JALLO RNC FNP-BC, WHNP-BCI
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Gender | Female
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Dates
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Enumeration Date | 07/14/2014
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Last Update Date | 07/14/2014
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Provider Practice Location Address
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Address Line | 604 DAM LAKE CT
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2796
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Country | US
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Telephone | 757-846-7510
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Fax |
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Provider Business Mailing Address
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Address Line | 604 DAM LAKE CT
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City | WILLIAMSBURG
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State | VA
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Zip | 23185-2796
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Country | US
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Telephone | 757-846-7510
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024092554
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 364SP1700X
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Taxonomy Name | Perinatal Clinical Nurse Specialist
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License Number | 0015000310
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License Number State | VA
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