Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2021-01-09
- Last updated
- 2022-01-20
Specialties
Licenses
- License CA
- 236166
- License DC
- CNM200004782
Location
- Practice location
- 3020 14TH ST NW
- City
- WASHINGTON DC
- Postal code
- 200096865
- Phone
- 202-469-4699
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
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Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.