Healthcare Provider Details

I. General information

NPI: 1588593784
Provider Name (Legal Business Name): KETURA DIAQUOI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 F ST NW STE 102
WASHINGTON DC
20037-2722
US

IV. Provider business mailing address

2112 F ST NW STE 102
WASHINGTON DC
20037-2722
US

V. Phone/Fax

Practice location:
  • Phone: 202-296-4455
  • Fax: 202-296-4455
Mailing address:
  • Phone: 202-296-4455
  • Fax: 202-822-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN500020714
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: