MEDICARE: ANGELICA FERNANDEZ DIZON NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	RN1004381	DC

General Provider Information

NPI Number	:	1023522638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELICA FERNANDEZ DIZON NP

Provider Business Mailing Address
First Line	:	1145 19TH ST NW STE 410
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-3716
Country	:	US
Telephone Number	:	202-331-1740
Fax Number	:

Provider Business Practice Location Address
First Line	:	1145 19TH ST NW STE 410
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20036-3716
Country	:	US
Telephone Number	:	202-331-1740
Fax Number	:	202-296-9784

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2017
Last Update Date	:	03/17/2018

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