Provider Demographics
NPI:1265776421
Name:ALIE, JARIATU (CNA)
Entity type:Individual
Prefix:
First Name:JARIATU
Middle Name:
Last Name:ALIE
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 CRANMER MEWS
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5304
Mailing Address - Country:US
Mailing Address - Phone:571-477-4422
Mailing Address - Fax:
Practice Address - Street 1:3506 CRANMER MEWS
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-5304
Practice Address - Country:US
Practice Address - Phone:571-477-4422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1401125552376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA$$$$$$$$$Medicaid