Provider Demographics
NPI:1831627082
Name:JABBIE, JOSEPHINE T
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:T
Last Name:JABBIE
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 1:6818 TREXLER RD
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3777
Mailing Address - Country:US
Mailing Address - Phone:301-220-3287
Mailing Address - Fax:
Practice Address - Street 1:6856 EASTERN AVE NW STE 320A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2112
Practice Address - Country:US
Practice Address - Phone:202-541-9844
Practice Address - Fax:202-541-9845
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-01
Last Update Date:2017-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1005335164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCLPN1005335Medicaid