Individual
SALY DAMIGOU MOUKDAGOU
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
REGISTERED NURSE
Contact information
Practice address
12255 FAIR LAKES PKWY, FAIRFAX, VA 22033-3952
(703) 934-5700
Mailing address
10821 CLOVER CT, MANASSAS, VA 20109-7246
(571) 267-0628
Taxonomy
Speciality
Code
Description
License number
State
163WP0807X
Child & Adolescent Psychiatric/Mental Health Registered Nurse
Primary
0001279380
VA
Other
Enumeration date
06/08/2020
Last updated
06/08/2020
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