Provider Demographics
NPI:1457077059
Name:NATHAN, VIJI (NP)
Entity Type:Individual
Prefix:
First Name:VIJI
Middle Name:
Last Name:NATHAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:VIJI
Other - Middle Name:NATHAN
Other - Last Name:OUELLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5015 NANTUCKET RD
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-4619
Mailing Address - Country:US
Mailing Address - Phone:301-520-4073
Mailing Address - Fax:
Practice Address - Street 1:5015 NANTUCKET RD
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-4619
Practice Address - Country:US
Practice Address - Phone:301-520-4073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR204147363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty