Healthcare Provider Details

I. General information

NPI: 1780151233
Provider Name (Legal Business Name): ETHEL E UWAJE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2512 24TH ST NE
WASHINGTON DC
20018-2126
US

IV. Provider business mailing address

6919 HEIDELBURG RD
LANHAM MD
20706-4602
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8340
  • Fax: 202-832-8341
Mailing address:
  • Phone: 240-547-8613
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHHA12363
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: