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Individual

PHANTA JAH

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
2833 CLEAVE DR., FALLS CHURCH, VA 22042
(800) 969-1104
Mailing address
2833 CLEAVE DR., FALLS CHURCH, VA 22042-1837
(180) 096-9110

Taxonomy

Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
0024182355
VA

Other

Enumeration date
08/01/2021
Last updated
08/01/2022
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