Basic Information
| Provider Information | |||||||||
| NPI: | 1073974077 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TABAIE | ||||||||
| FirstName: | MICHELE | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 19TH ST NW STE 410 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200363716 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023311740 | ||||||||
| FaxNumber: | 2022969784 | ||||||||
| Practice Location | |||||||||
| Address1: | 1145 19TH ST NW STE 410 | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2023311740 | ||||||||
| FaxNumber: | 2022969784 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/17/2016 | ||||||||
| LastUpdateDate: | 06/25/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LX0001X | 0017143992 | VA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363LX0001X | R226669 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363LX0001X | RN1043828 | DC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 95003611 | 01 | CA | NURSE PRACTITIONER FURNISHING | OTHER |