Healthcare Provider Details

I. General information

NPI: 1598218265
Provider Name (Legal Business Name): CLAUDINE ETANKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/29/2016
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 MARION BARRY AVE SE # DC20020
WASHINGTON DC
20020-3011
US

IV. Provider business mailing address

7851 RIVERDALE RD APT T3
NEW CARROLLTON MD
20784-4004
US

V. Phone/Fax

Practice location:
  • Phone: 202-866-7505
  • Fax:
Mailing address:
  • Phone: 240-467-4620
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12259
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: