Healthcare Provider Details

I. General information

NPI: 1508288820
Provider Name (Legal Business Name): AGNES ANIMASHAUN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AGNES OTUEDON-ANIMASHAUN

II. Dates (important events)

Enumeration Date: 01/07/2014
Last Update Date: 01/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MASSACHUSETTS AVE, SE, BLD 6,8 STD CLINIC
WASHINGTON DC
20003
US

IV. Provider business mailing address

899 NORTH CAPITOL STREET NE ROOM 4000 DISTRICT OF COLUMBIA DEPT. OF HEALTH, STD/ TB DIV.
DISTRICT OF COLUMBIA DC
20002
US

V. Phone/Fax

Practice location:
  • Phone: 202-698-4750
  • Fax:
Mailing address:
  • Phone: 202-671-4843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA30118
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: