Provider Demographics
NPI:1942015417
Name:NJECK, FEFE
Entity type:Individual
Prefix:
First Name:FEFE
Middle Name:
Last Name:NJECK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 WILLIAMSBURG CT
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22032-1139
Mailing Address - Country:US
Mailing Address - Phone:571-277-2929
Mailing Address - Fax:703-995-0364
Practice Address - Street 1:4021 WILLIAMSBURG CT
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22032-1139
Practice Address - Country:US
Practice Address - Phone:571-277-2929
Practice Address - Fax:703-995-0364
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA12777-03-0113747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant