Provider Demographics
NPI:1598049181
Name:ATTISHA, NADA
Entity Type:Individual
Prefix:MRS
First Name:NADA
Middle Name:
Last Name:ATTISHA
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 1:19397 MILL DAM PL
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:VA
Mailing Address - Zip Code:20176-1656
Mailing Address - Country:US
Mailing Address - Phone:248-470-3489
Mailing Address - Fax:
Practice Address - Street 1:19397 MILL DAM PL
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:VA
Practice Address - Zip Code:20176-1656
Practice Address - Country:US
Practice Address - Phone:248-470-3489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-01
Last Update Date:2011-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0202208592183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist