Individual
NAFISA SADE OUTLAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5804 N MARSHALL ST, PHILADELPHIA, PA 19120-1315
(268) 368-3955
Mailing address
5804 N MARSHALL ST, PHILADELPHIA, PA 19120-1315
(268) 368-3955
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
Primary
739258
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0813
—
PA
05
—
822689610
—
PA
Enumeration date
05/03/2022
Last updated
05/03/2022
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