Provider Demographics
NPI:1952872244
Name:JALLOH-CHAMBERLAIN, FATMATA TINA (REGESTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:FATMATA
Middle Name:TINA
Last Name:JALLOH-CHAMBERLAIN
Suffix:
Gender:F
Credentials:REGESTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12606 NICHOLS PROMISE DR
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20720-5602
Mailing Address - Country:US
Mailing Address - Phone:202-309-4674
Mailing Address - Fax:301-464-5301
Practice Address - Street 1:12606 NICHOLS PROMISE DR
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20720-5602
Practice Address - Country:US
Practice Address - Phone:301-464-5300
Practice Address - Fax:301-464-5301
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-11
Last Update Date:2018-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR166971163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty