Healthcare Provider Details

I. General information

NPI: 1740876390
Provider Name (Legal Business Name): SIAH HAWA BOCKARIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2020
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1615 KENILWORTH AVE NE
WASHINGTON DC
20019-2010
US

IV. Provider business mailing address

9508 UTICA PL
SPRINGDALE MD
20774-5447
US

V. Phone/Fax

Practice location:
  • Phone: 240-264-7448
  • Fax:
Mailing address:
  • Phone: 240-264-7448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500341138
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: