Provider Demographics
NPI:1164805529
Name:JALLOH, MARIAMA BOIE (NP)
Entity Type:Individual
Prefix:
First Name:MARIAMA
Middle Name:BOIE
Last Name:JALLOH
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 1:1201 S HAYES ST
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22202-2700
Mailing Address - Country:US
Mailing Address - Phone:703-418-3790
Mailing Address - Fax:
Practice Address - Street 1:1201 S HAYES ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2700
Practice Address - Country:US
Practice Address - Phone:703-418-3790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00241772692363LF0000X
VA0024172692363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily