Provider Demographics
NPI:1073974077
Name:TABAIE, MICHELE (NP)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:TABAIE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1145 19TH ST NW STE 410
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-3716
Mailing Address - Country:US
Mailing Address - Phone:202-331-1740
Mailing Address - Fax:202-296-9784
Practice Address - Street 1:1145 19TH ST NW STE 410
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036
Practice Address - Country:US
Practice Address - Phone:202-331-1740
Practice Address - Fax:202-296-9784
Is Sole Proprietor?:No
Enumeration Date:2016-03-17
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0017143992363LX0001X
MDR226669363LX0001X
DCRN1043828363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95003611OtherNURSE PRACTITIONER FURNISHING