Healthcare Provider Details

I. General information

NPI: 1366266157
Provider Name (Legal Business Name): MARGARET MBOE ETUKENI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 IRVING ST NW
WASHINGTON DC
20010-2927
US

IV. Provider business mailing address

8017 16TH ST NW
WASHINGTON DC
20012-1201
US

V. Phone/Fax

Practice location:
  • Phone: 202-291-1645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberRN967980
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: