Provider Demographics
NPI:1245839497
Name:MALIKE, ABDUL (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:ABDUL
Middle Name:
Last Name:MALIKE
Suffix:
Gender:M
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8010 GEORGE FOX PL
Mailing Address - Street 2:
Mailing Address - City:LORTON
Mailing Address - State:VA
Mailing Address - Zip Code:22079-2347
Mailing Address - Country:US
Mailing Address - Phone:703-819-4313
Mailing Address - Fax:
Practice Address - Street 1:8010 GEORGE FOX PL
Practice Address - Street 2:
Practice Address - City:LORTON
Practice Address - State:VA
Practice Address - Zip Code:22079-2347
Practice Address - Country:US
Practice Address - Phone:703-819-4313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-20
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024180291363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily