Healthcare Provider Details

I. General information

NPI: 1316648124
Provider Name (Legal Business Name): NEPHTUS M KILONZO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2023
Last Update Date: 05/10/2026
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 48TH ST NE # EAST
WASHINGTON DC
20019-3607
US

IV. Provider business mailing address

316 PRETTYMAN DR APT 6404
ROCKVILLE MD
20850-4771
US

V. Phone/Fax

Practice location:
  • Phone: 202-541-9844
  • Fax:
Mailing address:
  • Phone: 240-423-2617
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR205472
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN1041300
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: