Healthcare Provider Details

I. General information

NPI: 1902163637
Provider Name (Legal Business Name): JOSEPHINE KORONDO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2012
Last Update Date: 04/21/2025
Certification Date: 04/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1416 9TH ST NW
WASHINGTON DC
20001-3344
US

IV. Provider business mailing address

1416 9TH ST NW
WASHINGTON DC
20001-3344
US

V. Phone/Fax

Practice location:
  • Phone: 202-483-9111
  • Fax:
Mailing address:
  • Phone: 202-483-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN500014726
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: