Provider Demographics
NPI:1235761131
Name:HABIB, NORA (NP)
Entity Type:Individual
Prefix:
First Name:NORA
Middle Name:
Last Name:HABIB
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MISS
Other - First Name:NORA
Other - Middle Name:SAMY
Other - Last Name:MESDARY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:10983 CLARA BARTON DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX STATION
Mailing Address - State:VA
Mailing Address - Zip Code:22039-1432
Mailing Address - Country:US
Mailing Address - Phone:508-505-8300
Mailing Address - Fax:
Practice Address - Street 1:10983 CLARA BARTON DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX STATION
Practice Address - State:VA
Practice Address - Zip Code:22039-1432
Practice Address - Country:US
Practice Address - Phone:508-505-8300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-08
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024188110363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner