Healthcare Provider Details

I. General information

NPI: 1568971893
Provider Name (Legal Business Name): RAKECIA J HANNA MED. EARLY CHILDHOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2017
Last Update Date: 09/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 3RD ST SE
WASHINGTON DC
20003-3443
US

IV. Provider business mailing address

4907 S DAKOTA AVE NE
WASHINGTON DC
20017-3916
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-0316
  • Fax:
Mailing address:
  • Phone: 202-210-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: