Provider Demographics
NPI:1497327514
Name:JALLOW, AWA
Entity Type:Individual
Prefix:
First Name:AWA
Middle Name:
Last Name:JALLOW
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 1:6910 WOODSTREAM TURN
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2147
Mailing Address - Country:US
Mailing Address - Phone:240-505-8935
Mailing Address - Fax:
Practice Address - Street 1:6910 WOODSTREAM TURN
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2147
Practice Address - Country:US
Practice Address - Phone:240-505-8935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-16
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA00192682376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide