Provider Demographics
NPI:1841942406
Name:PROPHET, VIRGELLA JAKARA
Entity type:Individual
Prefix:
First Name:VIRGELLA
Middle Name:JAKARA
Last Name:PROPHET
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 1:3418 ABERDEEN ST
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-3103
Mailing Address - Country:US
Mailing Address - Phone:202-733-7848
Mailing Address - Fax:
Practice Address - Street 1:2 M ST NE APT 608
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3988
Practice Address - Country:US
Practice Address - Phone:202-826-0257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-24
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant