Provider Demographics
NPI:1023400314
Name:JASIM, AYAM
Entity Type:Individual
Prefix:
First Name:AYAM
Middle Name:
Last Name:JASIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:847 S HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-2644
Mailing Address - Country:US
Mailing Address - Phone:202-710-6973
Mailing Address - Fax:
Practice Address - Street 1:847 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-2644
Practice Address - Country:US
Practice Address - Phone:202-710-6973
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401172049376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide