MEDICARE: ALHAJI JALLOH MSN, APRN,FNP-C

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	0024188266	VA

General Provider Information

NPI Number	:	1326829854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALHAJI JALLOH MSN, APRN,FNP-C

Provider Business Mailing Address
First Line	:	12329 PURCELL RD
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20112-3208
Country	:	US
Telephone Number	:	703-349-9501
Fax Number	:

Provider Business Practice Location Address
First Line	:	4158 DALE BLVD
Second Line	:
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-2225
Country	:	US
Telephone Number	:	703-349-9501
Fax Number	:

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

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	10/10/2023

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