Provider Demographics
NPI:1528614245
Name:TARAWALIE, MARY WARRAH (APRN- PMHNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:WARRAH
Last Name:TARAWALIE
Suffix:
Gender:F
Credentials:APRN- PMHNP
Other - Prefix:
Other - First Name:ALUSINE
Other - Middle Name:
Other - Last Name:KAIKAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 12TH ST NW STE 700
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4052
Mailing Address - Country:US
Mailing Address - Phone:415-735-5804
Mailing Address - Fax:855-249-6362
Practice Address - Street 1:19703 EXECUTIVE PARK CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2639
Practice Address - Country:US
Practice Address - Phone:301-946-6623
Practice Address - Fax:301-946-1107
Is Sole Proprietor?:No
Enumeration Date:2019-08-18
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNP1028109363LF0000X, 363LP0808X
MDR202403363LP0808X, 363LF0000X
VA0024183031363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health