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NPI Code Detail

MEDICARE: MS. SUZIE FATOU JACKATEY NP

MEDICARE: MS. SUZIE FATOU JACKATEY 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
1363LF0000XFamily Nurse Practitioner209.017987IL

General Provider Information

NPI Number : 1700351442
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SUZIE FATOU JACKATEY NP
Provider Business Mailing Address
First Line : 1003 KINGS TREE DR
Second Line :
City : BOWIE
State : MD
Zip : 20721-1918
Country : US
Telephone Number : 857-999-6122
Fax Number :
Provider Business Practice Location Address
First Line : 14502 GREENVIEW DR STE 500
Second Line :
City : LAUREL
State : MD
Zip : 20708-4245
Country : US
Telephone Number : 857-999-6122
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2018
Last Update Date : 07/09/2023

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