Provider Demographics
NPI:1992378095
Name:HABA, MALLORIE MONTEITH (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:MALLORIE
Middle Name:MONTEITH
Last Name:HABA
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4501 AVIA CIR APT 124
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23233-7831
Mailing Address - Country:US
Mailing Address - Phone:919-475-6358
Mailing Address - Fax:
Practice Address - Street 1:7229 FOREST AVE STE 213
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-3765
Practice Address - Country:US
Practice Address - Phone:804-767-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA24181481363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner