| Organization Name: | CORNITA MENTAL HEALTH AND MEDICAL SERVICES, LLC |
| NPI Number: | 1134524580 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CORDELIA NIEKETIEN-TAWARI (PRESIDENT/NURSE PRACTITIONER) |
| Mailing Address: | 12801 Worldgate Dr 500-525a Herndon |
| State: | VA US |
| Postal Code: | 201704393 |
| Phone Number: | 7038719334 |
| Fax Number: | 7033273229 |
| NPI Enumeration Date: | 10/28/2014 |
| NPI Last Update Date: | 01/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163W00000X |
| License Number: | 0017137987 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | VA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A registered nurse is a person qualified by graduation from an accredited nursing school (depending upon schooling, a registered nurse may receive either a diploma from a hospital program, an associate degree in nursing (A.D.N.) or a Bachelor of Science degree in nursing (B.S.N.), who is licensed or certified by the state, and is practicing within the scope of that license or certification. R.N. |