Healthcare Provider Details

I. General information

NPI: 1770842379
Provider Name (Legal Business Name): ERNEST N ETAHKWELLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 03/08/2026
Certification Date: 03/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 BLADENSBURG RD NE
WASHINGTON DC
20018-2235
US

IV. Provider business mailing address

7006 GOOD LUCK RD
LANHAM MD
20706-3709
US

V. Phone/Fax

Practice location:
  • Phone: 202-635-3577
  • Fax:
Mailing address:
  • Phone: 240-413-3437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number2966135
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: