Healthcare Provider Details

I. General information

NPI: 1427891811
Provider Name (Legal Business Name): DISTRICT WELLNESS SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4523 ALABAMA AVE SE
WASHINGTON DC
20019-4912
US

IV. Provider business mailing address

4523 ALABAMA AVE SE
WASHINGTON DC
20019-4912
US

V. Phone/Fax

Practice location:
  • Phone: 202-255-2574
  • Fax:
Mailing address:
  • Phone: 202-255-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LYNNJULIE AUGUSTINE NKWABA
Title or Position: MANAGER
Credential:
Phone: 202-498-8094