Provider Demographics
NPI:1427898576
Name:TRAMMELL, MARIYAH
Entity type:Individual
Prefix:
First Name:MARIYAH
Middle Name:
Last Name:TRAMMELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5290 SHAWNEE RD STE 103
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-2381
Mailing Address - Country:US
Mailing Address - Phone:703-259-7278
Mailing Address - Fax:
Practice Address - Street 1:5290 SHAWNEE RD STE 103
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-2381
Practice Address - Country:US
Practice Address - Phone:703-259-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-28
Last Update Date:2024-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAHCO-00052963747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant