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General NPI Number Information
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NPI Number | 1962121244
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Entity Type | Individual
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Provider Name | DAGMAWIT HAILE BEHAILU
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Gender | Female
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Dates
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Enumeration Date | 08/22/2022
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 3300 GALLOWS RD
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City | FALLS CHURCH
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State | VA
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Zip | 22042-3307
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Country | US
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Telephone | 703-776-3544
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Fax |
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Provider Business Mailing Address
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Address Line | 3510 SHANDOR RD
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City | WOODBRIDGE
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State | VA
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Zip | 22193-5785
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Country | US
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Telephone | 703-498-8490
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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 | F07221124
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License Number State | VA
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