Healthcare Provider Details

I. General information

NPI: 1396220075
Provider Name (Legal Business Name): NIKITA RENEE WARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2018
Last Update Date: 09/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 M ST NE APT 1
WASHINGTON DC
20002-2036
US

IV. Provider business mailing address

5240 CLAY ST NE
WASHINGTON DC
20019-6638
US

V. Phone/Fax

Practice location:
  • Phone: 202-607-8490
  • Fax:
Mailing address:
  • Phone: 202-680-0230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License NumberDENA000520
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: