Healthcare Provider Details

I. General information

NPI: 1386356202
Provider Name (Legal Business Name): ALVONETTE KOLOA GRIMES HEALTH EDUCATOR SPEC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2022
Last Update Date: 12/22/2022
Certification Date: 12/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

839 52ND ST NE
WASHINGTON DC
20019-5512
US

IV. Provider business mailing address

839 52ND ST NE
WASHINGTON DC
20019-5512
US

V. Phone/Fax

Practice location:
  • Phone: 202-277-3389
  • Fax:
Mailing address:
  • Phone: 202-277-3389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: