Nafisa Sade Outlaw

Primary specialty

Military Health Care ProviderTaxonomy code 171000000X

License

739258 Issued in PA

Practice address

5804 N Marshall St
Philadelphia, PA 19120-1315

Phone

(268) 368-3955

NPI assigned

May 3, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1651536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651536000000",
    "number": "1760127773",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5804 N MARSHALL ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191201315",
            "telephone_number": "268-368-3955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5804 N MARSHALL ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191201315",
            "telephone_number": "268-368-3955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OUTLAW",
        "first_name": "NAFISA",
        "middle_name": "SADE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-03",
        "last_updated": "2022-05-03",
        "certification_date": "2022-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Military Health Care Provider",
            "state": "PA",
            "license": "739258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0813",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "822689610",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Out Reach Caregiving Services LLC
• Alexis Outerbridge
• Nhakia Outland
• Elizabeth Ann Iliescu Outlaw, PA-C
• Gavin Ahsaiah Outlaw
• Outside the Box Strategies, LLC
• Tamara Ouzounian, MD
• Charyl Ovalle, M.D.
• Massiel N Ovalles Perdomo
• Ryan Overberger, DO

• Military Health Care Provider in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Military Health Care Provider in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.