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Nafisa Sade Outlaw
Military Health Care Provider in Philadelphia, Pennsylvania
NPI 1760127773

Nafisa Sade Outlaw is a Military Health Care Provider based in Philadelphia, PA. Nafisa Sade Outlaw practices in Philadelphia, PA. The NPI Number for Nafisa Sade Outlaw is 1760127773 and holds a License No. 739258 (Pennsylvania).

The current practice location address for Nafisa Sade Outlaw is 5804 N Marshall St, Philadelphia, PA and can be reached out via phone at 268-368-3955.

Location: 5804 N Marshall St, Philadelphia, PA, 19120-1315
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Provider Profile Details
NPI Number
1760127773
Provider Name
Nafisa Sade Outlaw
Credential
Provider Entity Type
Individual
Gender
Female
Address
5804 N Marshall St, Philadelphia, PA, 19120-1315
Phone Number
268-368-3955
Fax Number
Provider Enumeration Date
05/03/2022
Last Update Date
03/10/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
0813 05 PA
822689610 05 PA
institution
Provider Business Practice Location Address Details
Address
5804 N Marshall St
City
State
Zip
19120-1315
Phone Number
268-368-3955
Fax Number
person
Provider Business Mailing Address Details
Address
5804 N Marshall St
City
State
Zip
19120-1315
Phone Number
268-368-3955
Fax Number
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Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Military Health Care Provider
Speciality
-
Taxonomy
License No.
739258 (Pennsylvania)
Definition
Active duty military health care providers not otherwise classified who need to be separately identified for operational, clinical, or administrative processes.
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