Provider Demographics
NPI:1689030942
Name:ABDULMANNAN, NASREEN
Entity Type:Individual
Prefix:
First Name:NASREEN
Middle Name:
Last Name:ABDULMANNAN
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 1:10524 ROSEHAVEN ST
Mailing Address - Street 2:APT. 113
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-2865
Mailing Address - Country:US
Mailing Address - Phone:703-505-8366
Mailing Address - Fax:
Practice Address - Street 1:7601 LITTLE RIVER TPKE
Practice Address - Street 2:SUITE 215
Practice Address - City:ANNANDALE
Practice Address - State:VA
Practice Address - Zip Code:22003-2601
Practice Address - Country:US
Practice Address - Phone:703-791-9480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-01
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR195371364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health